Provider Demographics
NPI:1659329688
Name:EHRLICH, BRIAN S (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:EHRLICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:196 PARKWAY SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-443-3980
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT21381207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0V9734OtherHELATHNET/ECCD:06-1616101
P2523176OtherOXFORD/ECCD: 06-1616101
CT001213818Medicaid
06-1616101OtherCOMM. HEALTH NETWORK/ECCD
010021381CT01OtherANTHEM/ECCG:06-1049086
010021381CT04OtherANTHEM/ECCD:06-1616101
06-1616101OtherUNITEDHEALTHCARE/ECCD
060064821OtherRR MED/ECCD: 06-1616101
001213818OtherBLUECARE FAMILY PLAN
021381OtherCONNECTICARE
030250OtherHEALTHNET/ECCG:06-1049086
06-1049086OtherCOMM. HEALTH NETWORK/ECCG
06-1049086OtherUNITEDHEALTHCARE/ECCG
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD
060014259OtherRR MED/ECCG: 06-1049086
NLS102OtherOXFORD /ECCG: 06-1049086
CT001213818Medicaid
021381OtherCONNECTICARE
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD