Healthcare Provider Details

I. General information

NPI: 1588830566
Provider Name (Legal Business Name): EDOUARD ABOIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 12/22/2019
Certification Date: 12/22/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

300 GEORGE ST
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-6621
  • Fax:
Mailing address:
  • Phone: 203-785-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number64481
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC55936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: