Provider Demographics
NPI:1063423028
Name:SADEGHI, HOSSEIN (MD)
Entity type:Individual
Prefix:
First Name:HOSSEIN
Middle Name:
Last Name:SADEGHI
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 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:SUITE 11
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-5949
Mailing Address - Fax:203-276-4097
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 11
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-5949
Practice Address - Fax:203-276-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035629174400000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH09513Medicare UPIN