OMAR IBRAHIM (Credential# 1221738) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
OMAR IBRAHIM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.053313. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001. The current status is active.
| Licensee Name | OMAR IBRAHIM |
| Credential ID | 1221738 |
| Credential Number | 1.053313 |
| Credential Type | Physician/Surgeon |
| Business Address |
263 Farmington Ave # Mc-1321 Farmington CT 06030-0001 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2014-07-16 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-05-11 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1220410 | CSP.0057120 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2014-07-17 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 263 FARMINGTON AVE # MC-1321 |
| City | FARMINGTON |
| State | CT |
| Zip Code | 06030-0001 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| John Tejada | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2015-03-01 ~ 2017-02-28 |
| Timothy Coyle | 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 | Controlled Substance Registration for Practitioner | 2013-03-01 ~ 2015-02-28 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Wendy A Miller | Mc1921 Farmington Ave # 263, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jason J Ziegler | 2 Courthouse Square, Farmington, CT 06030-0001 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Bryden T Considine | L2104 of Medicine Rm, Farmington, CT 06030-0001 | Resident Physician | 2017-07-03 ~ 2021-06-30 |
| Dillon Paulo | 4260 Cordoba Ct, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2024-06-30 |
| Erica Shen Nofziger | 263 Farmington Ave, Farmington, CT 06030-0001 | Resident Physician | 2020-07-01 ~ 2027-06-30 |
| Jillian L Fortier | Uconn Health Center, Department of Surgery, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Douglas Zelisko | 263 Farmington Ave Dept Of, Farmington, CT 06030-0001 | Physician/surgeon | 2020-04-23 ~ 2021-01-31 |
| Ruchir D Trivedi | 263 Farmington Ave # Mc-1405, Farmington, CT 06030-0001 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Rawan J.j. Sarsour | 263 Farmington Ave # Mc3905, Farmington, CT 06030-0001 | Provisional Faculty Dentist | 2020-04-21 ~ 2021-04-30 |
| Angela Hart | General Medicine- Outpatient Pavilion, Farmington, CT 06030-0001 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Find all Licenses in zip 06030-0001 | |||
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Eric Anthony Brueckner | 263 Farmington Ave., Farmington, CT 06030 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Derrick B Bremang | Residency Program, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-06-30 |
| David M Shafer | Uconn Health Center, Farmington, CT 06030 | Dentist | 2020-07-01 ~ 2021-06-30 |
| Michael J Murphy | Dept of Dermatology, Farmington, CT 06030 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Richard F Kaplan | Univ. of Ct., Farmington, CT 06030 | Psychologist | 2020-06-01 ~ 2021-05-31 |
| Nicholas George Vitale | 22 Woods Drive, Norwich, CT 06030 | Casino Class I Employee | 2019-12-03 ~ 2020-10-31 |
| Bruce E Gould | Univ of Conn Health Center, Farmington, CT 06030 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Vinayak M Sathe | Uconn Health Center,263 Farmington Ave, Farmington, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Shobhana Pathani | Department of Medicine, 263 Farmington Ave, CT 06030 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Patricia L Almeida | John Dempsey Hospital, Farmington, CT 06030 | Registered Nurse | 2020-04-01 ~ 2021-03-31 |
| Find all Licenses in zip 06030 | |||
| City | FARMINGTON |
| Zip Code | 06030 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + FARMINGTON |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ibrahim & Ibrahim Engrs | 42 Border St, Deedham, MA 02026 | Professional Engineer | 1988-03-11 ~ 1989-01-31 |
| Khalid Ibrahim | 555 E 5th Street, Brooklyn, NY 11218 | Physician/surgeon | ~ |
| Ibrahim A Hirbawi | P.o. Box 12098, Jerusalem, 91120 | Physician/surgeon | 2011-02-10 ~ 2012-01-31 |
| Ibrahim I Jabbour | 171 Grandview Ave, Waterbury, CT 06708 | Physician/surgeon | 2019-04-01 ~ 2020-03-31 |
| Ibrahim N Orgun | 44 Craigemore Circle, Avon, CT 06001 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Fadi Ibrahim | 150 Collins Street, Memphis, TN 38112 | Physician/surgeon | 2011-02-01 ~ 2012-01-31 |
| Sherif Ibrahim | 200 Watson Blvd, Stratford, CT 06615 | Physician/surgeon | 2019-01-01 ~ 2019-12-31 |
| Ibrahim W Malak | 4822 N Linder Ave Apt 2, Chicago, IL 60630-3454 | Physician/surgeon | 2001-09-10 ~ 2002-09-30 |
| Sherif Ibrahim | 2324 Oak Ridge Dr., Troy, MI 48098 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Ibrahim F Hitti | 73 Turf Lane, Roslyn Heights, NY 11577 | Physician/surgeon | 2009-06-11 ~ 2010-06-30 |
Please comment or provide details below to improve the information on OMAR IBRAHIM.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).