Provider Demographics
NPI:1114109485
Name:AYEPAH, MICHAEL ADRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADRIAN
Last Name:AYEPAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL STREET
Mailing Address - Street 2:HSR FACULTY PRACTICE MAIN 232
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-3034
Mailing Address - Fax:203-789-5184
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3034
Practice Address - Fax:203-789-5184
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT46491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110010670Medicare PIN