Provider Demographics
NPI:1992767826
Name:ANIS-ANWAR, YUSRA (MD)
Entity type:Individual
Prefix:
First Name:YUSRA
Middle Name:
Last Name:ANIS-ANWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 ROCKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1550
Mailing Address - Country:US
Mailing Address - Phone:860-478-0882
Mailing Address - Fax:
Practice Address - Street 1:216 HEMLOCK AVE STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-9607
Practice Address - Country:US
Practice Address - Phone:860-697-6565
Practice Address - Fax:860-730-4661
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010036134CT03OtherANTHEM
CT101668OtherCTCARE
CT1992767826Medicaid
CT010036134CT03OtherANTHEM