Provider Demographics
NPI:1164461091
Name:VAHIDY, MISBAH M (MD)
Entity Type:Individual
Prefix:
First Name:MISBAH
Middle Name:M
Last Name:VAHIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 SILVER LN
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1257
Mailing Address - Country:US
Mailing Address - Phone:860-569-7399
Mailing Address - Fax:860-895-8107
Practice Address - Street 1:677 SILVER LN
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1257
Practice Address - Country:US
Practice Address - Phone:860-568-7243
Practice Address - Fax:860-895-8107
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019550207Q00000X
CT19550208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010019550CTOtherBLUE CARE
CT442021029OtherMEDICARE(RAILROAD)
CT010019550CT04OtherANTHEM BC BS
CT773649OtherCONNECTCARE
CT00119550201OtherBLUE CARE MEDICAID
CT060973659-000OtherPRUDENTIAL
CTOR2004OtherHEALTHNET
CTP02348OtherCOMMUNITY HEALTH NETWORK
CTP384233OtherOXFORD
CT0004124179OtherAETNA
CT061400843OtherBANKERS LIFE AND CASUALTY
CT1703674OtherCIGNA
CT2169866OtherAETNA USHEALTHCARE HMO
CT001195502Medicaid
CT061400843OtherTRICARE
CT1703674OtherCIGNA
CT442021029OtherMEDICARE(RAILROAD)