MEDICARE: DR. NAMI BAYAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	046285	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760413538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAMI BAYAN MD

Provider Business Mailing Address
First Line	:	2 IVY BROOK RD
Second Line	:	STE 120
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-513-2642
Fax Number	:	203-513-2638

Provider Business Practice Location Address
First Line	:	2 IVY BROOK RD
Second Line	:	STE 120
City	:	SHELTON
State	:	CT
Zip	:	06484-6416
Country	:	US
Telephone Number	:	203-513-2642
Fax Number	:	203-513-2638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	12/17/2013

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