Provider Demographics
NPI:1861475931
Name:MOHSENIN, VAHID (MD)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:MOHSENIN
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 1:789 HOWARD AVE
Mailing Address - Street 2:FITKIN BUILDING - 2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-785-3207
Mailing Address - Fax:203-785-3826
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:FITKIN BUILDING - 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-785-3207
Practice Address - Fax:203-785-3826
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022446207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001224468Medicaid
CT110003372Medicare ID - Type Unspecified
CT001224468Medicaid