Healthcare Provider Details

I. General information

NPI: 1326385428
Provider Name (Legal Business Name): HOSSEIN L. TEHRANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 EAST HYERDALE DRIVE
GOSHEN CT
06756
US

IV. Provider business mailing address

49 EAST HYERDALE DRIVE
GOSHEN CT
06756
US

V. Phone/Fax

Practice location:
  • Phone: 860-491-9148
  • Fax:
Mailing address:
  • Phone: 860-491-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number14772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: