Provider Demographics
NPI:1497377576
Name:ROUZBEHANI SELAKHOR, JAHANGIR (MD)
Entity Type:Individual
Prefix:
First Name:JAHANGIR
Middle Name:
Last Name:ROUZBEHANI SELAKHOR
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 1:24 HOSPITAL AVE., 5 WEST
Mailing Address - Street 2:KATHLEEN BARRY
Mailing Address - City:DANBURT
Mailing Address - State:CT
Mailing Address - Zip Code:06810
Mailing Address - Country:US
Mailing Address - Phone:203-739-8105
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE. 06810-6099
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:866-374-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-11-16
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT76185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program