Provider Demographics
NPI:1386663243
Name:SCHEIN, IAN D (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:D
Last Name:SCHEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:203-503-6515
Practice Address - Street 1:121 WAKELEE AVE
Practice Address - Street 2:ANSONIA CLINIC
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401
Practice Address - Country:US
Practice Address - Phone:203-503-3570
Practice Address - Fax:203-503-3589
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78790207R00000X
CT33443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0402495OtherCIGNA
754248OtherTUFTS COMM HEALTH PLAN
48943OtherFALLON COMM HEALTH PLAN
484334OtherCONNECTICARE
984978OtherNETWORK HEALTH
J14504OtherBLUE CROSS BLUE SHIELD
MA1334432Medicaid
4390371OtherHEALTHSOURCE CMHC
CT004235900Medicaid
69608OtherHARVARD PILGRIM
F62391Medicare UPIN