Provider Demographics
NPI:1356340319
Name:QADIR, MUHAMMAD EHSAN (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:EHSAN
Last Name:QADIR
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 1:22 WESTFIELD AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1158
Mailing Address - Country:US
Mailing Address - Phone:203-732-1677
Mailing Address - Fax:203-732-1680
Practice Address - Street 1:22 WESTFIELD AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1158
Practice Address - Country:US
Practice Address - Phone:203-732-1677
Practice Address - Fax:203-732-1680
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-03-06
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CT025164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001251644Medicaid
CT1356340319Medicare PIN
CTD100000029Medicare PIN
CT001251644Medicaid
1154573657Medicare PIN