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NPI Code Detail

MEDICARE: DR. MAHSA AVA SOHRAB M.D.

MEDICARE: DR. MAHSA AVA SOHRAB M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician55552CT
2207WX0200XOphthalmic Plastic and Reconstructive Surgery Physician2844671NY
3207WX0200XOphthalmic Plastic and Reconstructive Surgery Physician55552CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A400150908OTHERNYMEDICARE

General Provider Information

NPI Number : 1275845331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAHSA AVA SOHRAB M.D.
Provider Business Mailing Address
First Line : 25 VALLEY DR STE 2B
Second Line :
City : GREENWICH
State : CT
Zip : 06831-5203
Country : US
Telephone Number : 203-340-1301
Fax Number : 442-223-0286
Provider Business Practice Location Address
First Line : 25 VALLEY DR STE 2B
Second Line :
City : GREENWICH
State : CT
Zip : 06831-5203
Country : US
Telephone Number : 203-340-1301
Fax Number : 442-223-0286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2010
Last Update Date : 03/22/2023

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