Healthcare Provider Details

I. General information

NPI: 1164461091
Provider Name (Legal Business Name): MISBAH M VAHIDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 SILVER LN
EAST HARTFORD CT
06118-1257
US

IV. Provider business mailing address

677 SILVER LN
EAST HARTFORD CT
06118-1257
US

V. Phone/Fax

Practice location:
  • Phone: 860-568-7243
  • Fax: 860-895-8107
Mailing address:
  • Phone: 860-569-7399
  • Fax: 860-895-8107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number019550
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19550
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: