Qaiyum Mujtaba, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

16546 Issued in CT

Practice address

750 Savin Ave
West Haven, CT 06516-4314

Phone

(203) 931-7710

NPI assigned

Jan 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1366420184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 TIMBERLANE DR",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064772844",
            "telephone_number": "203-931-7710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 SAVIN AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164314",
            "telephone_number": "203-931-7710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUJTABA",
        "first_name": "QAIYUM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "16546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1165463",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherri Moser, RN
• Gissell Mota
• John G Moyher, PHARMD
• Kathleen Mrazik
• Lily Anne Mudre, LPC-A
• Christina Mukon, DNP
• Maura Elizabeth Mullen, PHARMD
• Ryan Dale Muller, DC
• Rogehni Nono Munoz, R.N., B.S.N.
• Cassandra Murphy, M.D.

• Internal Medicine Physician in West Haven, CT
• Providers in West Haven, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.