Provider Demographics
NPI:1396722575
Name:VAEZY, ALI (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:VAEZY
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 1:20 YORK ST
Mailing Address - Street 2:YNHH WEST PAVILION, 2ND FL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-785-4081
Mailing Address - Fax:203-737-2228
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH WEST PAVILION, 2ND FL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-4081
Practice Address - Fax:203-737-2228
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT040741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001407411Medicaid
CT220133OtherWELLCARE
CT3408207/7603504OtherAETNA
CT23-33843OtherUHC
CTPENDINGOtherRR MEDICARE
CT23-33843OtherAMERICHOICE
CT912708OtherUSA
CT010040741CT02OtherANTHEM BCBS CT
CT040741OtherCONNECTICARE
CT2V1459OtherHEALTHNET/COMMERCIAL
CTP2978576OtherOXFORD
CT3408207/7603504OtherAETNA
CTP2978576OtherOXFORD
H97360Medicare UPIN