Provider Demographics
NPI:1952563736
Name:AYACH, MOUHANAD (MD)
Entity Type:Individual
Prefix:
First Name:MOUHANAD
Middle Name:
Last Name:AYACH
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 1:85 SEYMOUR ST STE 409
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5523
Mailing Address - Country:US
Mailing Address - Phone:860-522-4158
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 409
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5523
Practice Address - Country:US
Practice Address - Phone:605-224-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT642262086S0129X
MA237270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery