Provider Demographics
NPI:1578583282
Name:ARIYAN, STEPHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:
Last Name:ARIYAN
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 1:60 TEMPLE ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-786-3000
Mailing Address - Fax:203-772-2814
Practice Address - Street 1:60 TEMPLE ST STE 7C
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-786-3000
Practice Address - Fax:203-772-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0136812086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001136811Medicaid
CT001136811Medicaid
CT240000076Medicare ID - Type UnspecifiedPROVIDER NUMBER