Healthcare Provider Details

I. General information

NPI: 1316200769
Provider Name (Legal Business Name): PAYAM SAJEDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FOUNDERS PLZ STE 400
EAST HARTFORD CT
06108-3240
US

IV. Provider business mailing address

111 FOUNDERS PLZ STE 400
EAST HARTFORD CT
06108-3240
US

V. Phone/Fax

Practice location:
  • Phone: 860-289-3375
  • Fax: 860-783-5733
Mailing address:
  • Phone: 860-289-3375
  • Fax: 860-783-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT202291
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number59982
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: