Healthcare Provider Details

I. General information

NPI: 1952563736
Provider Name (Legal Business Name): MOUHANAD AYACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 409
HARTFORD CT
06106-5523
US

IV. Provider business mailing address

85 SEYMOUR ST STE 409
HARTFORD CT
06106-5523
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-1588
  • Fax:
Mailing address:
  • Phone: 860-522-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number64226
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number237270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: