Provider Demographics
NPI:1649211038
Name:BHAYA, MAHESH H (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:H
Last Name:BHAYA
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 1:21 W MAIN ST
Mailing Address - Street 2:ONE EXCHANGE PLACE BLDG-3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2013
Mailing Address - Country:US
Mailing Address - Phone:203-574-3777
Mailing Address - Fax:203-755-1708
Practice Address - Street 1:21 W MAIN ST
Practice Address - Street 2:ONE EXCHANGE PLACE BLDG-3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2013
Practice Address - Country:US
Practice Address - Phone:203-574-3777
Practice Address - Fax:203-755-1708
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041488207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001414888Medicaid
CT040000376Medicare ID - Type UnspecifiedINDIVIDUAL I.D. NUMBER
CT001414888Medicaid