Provider Demographics
NPI:1023077609
Name:DAHHAN, HAZAR (MD)
Entity type:Individual
Prefix:PROF
First Name:HAZAR
Middle Name:
Last Name:DAHHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-3540
Mailing Address - Country:US
Mailing Address - Phone:860-643-5443
Mailing Address - Fax:860-643-9399
Practice Address - Street 1:201 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3540
Practice Address - Country:US
Practice Address - Phone:860-643-5443
Practice Address - Fax:860-643-9399
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028665207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001286659Medicaid
CT028665OtherSTATE MEDICAL LICENSE
CT001286659Medicaid
CTD400007070Medicare PIN