Provider Demographics
NPI:1508021809
Name:ARDESHIRPOUR, LALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:LALEH
Middle Name:
Last Name:ARDESHIRPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3026
Mailing Address - Country:US
Mailing Address - Phone:203-288-4288
Mailing Address - Fax:203-288-1566
Practice Address - Street 1:299 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3026
Practice Address - Country:US
Practice Address - Phone:203-248-9371
Practice Address - Fax:855-609-2616
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0430512080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT8002773Medicaid