Basic Information
| Provider Information | |||||||||
| NPI: | 1467458075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAHEY | ||||||||
| FirstName: | MARIANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 687 CAMPBELL AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065163774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039326481 | ||||||||
| FaxNumber: | 2039324051 | ||||||||
| Practice Location | |||||||||
| Address1: | 687 CAMPBELL AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065163774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039327481 | ||||||||
| FaxNumber: | 2039324051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 030088 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001300889 | 05 | CT | MEDICAID | 010030088CT07 | 01 | CT | ANTHEM BLUE SHIELD | OTHER | 008803 | 01 | CT | CONNECTICARE | OTHER | 2V5205 | 01 | CT | HEALTHNET | OTHER | 4126016 | 01 | CT | AETNA | OTHER | P3362191 | 01 | CT | OXFORD | OTHER | P00141373 | 01 | CT | RAILROAD MEDICARE | OTHER |