MARIAM TSIKVADZE
Resident Physician


Address: 263 Farmington Ave, Farmington, CT 06030-0001

MARIAM TSIKVADZE (Credential# 1529951) is licensed (Resident Physician) with Connecticut Department of Consumer Protection. The license effective date is June 28, 2018. The license expiration date date is June 30, 2022. The license status is ACTIVE.

Business Overview

MARIAM TSIKVADZE is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.061626-RES. The credential type is resident physician. The effective date is June 28, 2018. The expiration date is June 30, 2022. The business address is 263 Farmington Ave, Farmington, CT 06030-0001. The current status is active.

Basic Information

Licensee Name MARIAM TSIKVADZE
Credential ID 1529951
Credential Number 1.061626-RES
Credential Type Resident Physician
Credential SubCategory RES
Business Address 263 Farmington Ave
Farmington
CT 06030-0001
Business Type INDIVIDUAL
Status ACTIVE - CURRENT
Active 1
Issue Date 2018-06-28
Effective Date 2018-06-28
Expiration Date 2022-06-30
Refresh Date 2018-07-12

Other licenses

ID Credential Code Credential Type Issue Term Status
1530890 CSP.0069086 CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER 2018-07-17 2019-03-01 - 2021-02-28 ACTIVE

Other locations

Licensee Name Office Address Credential Effective / Expiration
Mariam Tsikvadze 263 Farmington Avenue, Farmington, CT 06030-1921 Resident Physician 2018-06-28 ~ 2018-07-27

Office Location

Street Address 263 FARMINGTON AVE
City FARMINGTON
State CT
Zip Code 06030-0001

Licenses in the same location

Licensee Name Office Address Credential Effective / Expiration
Erica Shen Nofziger 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2027-06-30
Matthew D Goranson 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2026-06-30
Jacob Silver 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2025-06-30
Nicholas Bellas 263 Farmington Ave, Farmington, CT 06032-1956 Resident Physician 2020-07-01 ~ 2025-06-30
Jennifer Hale 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2025-06-30
Cory R Hewitt 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2025-06-30
Sango Huwaa Mosia Asante 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2025-06-30
Ryan Desrochers 263 Farmington Ave, Farmington, CT 06030-0001 Resident Physician 2020-07-01 ~ 2025-06-30
Kelsey D Greenhalgh 263 Farmington Ave, Farmington, CT 06030-0001 Resident Dentist 2019-07-01 ~ 2025-06-30
Derek J Tow 263 Farmington Ave, Farmington, CT 06030-0001 Resident Dentist 2019-07-01 ~ 2025-06-30
Find all Licenses in the same address

Licenses in the same zip code

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
Omar Ibrahim 263 Farmington Ave # Mc-1321, Farmington, CT 06030-0001 Physician/surgeon 2020-06-01 ~ 2021-05-31
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

Licenses in the same zip code

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

Competitor

Search similar business entities

City FARMINGTON
Zip Code 06030
License Type Resident Physician
License Type + County Resident Physician + FARMINGTON

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Dataset Information

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).

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