Provider Demographics
NPI:1629113980
Name:FAHMI, NASIHA
Entity Type:Individual
Prefix:
First Name:NASIHA
Middle Name:
Last Name:FAHMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NASIHA
Other - Middle Name:
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-0762
Mailing Address - Country:US
Mailing Address - Phone:203-795-3617
Mailing Address - Fax:203-795-3618
Practice Address - Street 1:240 INDIAN RIVER RD
Practice Address - Street 2:SUITE C2
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3649
Practice Address - Country:US
Practice Address - Phone:203-795-3617
Practice Address - Fax:203-795-3618
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0407779OtherUNITED HEALTHCARE
CT2594704OtherGREAT WEST HEALTHCARE
CT010039637CT05OtherANTHEM BCBS
CT0Q3209OtherHEALTHNET
CT2633204OtherAETNA
CTP00157811OtherU.S. RAILROAD MEDICARE
CTP2546380OtherOXFORD
CT001396375Medicaid
CT039637OtherCONNECTICARE
CT244430OtherWELLCARE
CT201475344OtherCIGNA
CT201475344OtherCOMMERIAL
CT201475344OtherCOMMERIAL
CT0407779OtherUNITED HEALTHCARE