Provider Demographics
NPI:1336386853
Name:EHSANI, HAMID (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:EHSANI
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 1:100 GRAND ST
Mailing Address - Street 2:HOSPITAL OF CENTRAL CONNECTICUT
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052
Mailing Address - Country:US
Mailing Address - Phone:860-224-5675
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010229207P00000X
CT047405207P00000X
CA179463207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0RE5918Medicaid
OHEH 0899011Medicaid
NH30201072Medicaid
NHRE5918OtherMEDICARE ID #