Provider Demographics
NPI:1841236312
Name:ANSARI, EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EHSAN
Other - Middle Name:
Other - Last Name:ANSARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:455 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3303
Mailing Address - Country:US
Mailing Address - Phone:203-573-1435
Mailing Address - Fax:203-755-7433
Practice Address - Street 1:455 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3352
Practice Address - Country:US
Practice Address - Phone:203-573-1435
Practice Address - Fax:203-755-7433
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043316207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043316OtherCONNECTICARE
CT18-07336OtherUHC
CT2V5637OtherHEALTHNET/COMMERCIAL
CT1807336OtherUNITED HEALTHCARE
CT2V6532OtherHEALTH NET OF NORTHEAST
CT980014OtherUSA
CTP3612135OtherOXFORD HEALTH PLANS
CT010043316CT01OtherANTHEM BC & BS
CT1841236312Medicaid
CT18-07336OtherAMERICHOICE
CT5937452OtherAETNA HEALTH PLANS
043316OtherCONNECTICARE
CTP00231450OtherRAILROAD MEDICARE
CT301027OtherWELLCARE
CT001433169Medicaid
CT010043316CT02OtherANTHEM BCBS CT
CT6980371OtherCIGNA HEALTH PLANS
CT043316OtherCONNECTICARE
CT010043316CT02OtherANTHEM BCBS CT
CT1841236312Medicaid