Basic Information
| Provider Information | |||||||||
| NPI: | 1821001728 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOHAMMADI | ||||||||
| FirstName: | SHAHRZAD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | ONE HOSPITAL PLAZA | ||||||||
| Address2: | THE STAMFORD HOSPITAL | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069049317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767831 | ||||||||
| FaxNumber: | 2032767548 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE HOSPITAL PLAZA | ||||||||
| Address2: | THE STAMFORD HOSPITAL | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069049317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767831 | ||||||||
| FaxNumber: | 2032767548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 04/15/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036747 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2215007 | 01 | CT | UNITED HEALTHCARE | OTHER | 7585379 | 01 | CT | AETNA | OTHER | TIN | 01 | CONSUMER HEALTH NETWORK | OTHER | 5B8191 | 01 | CT | EMPIRE BC/BS | OTHER | 010036747CT01 | 01 | CT | ANTHEM BC/BS | OTHER | 1793250 | 01 | CT | CIGNA | OTHER | TIN | 01 | NEHCA | OTHER | TIN | 01 | PIONEER | OTHER | TIN | 01 | MULTIPLAN | OTHER | P2670279 | 01 | CT | OXFORD HEALTH PLAN | OTHER | TIN | 01 | MANAGED CARE STATEGIES | OTHER | TIN | 01 | FOCUS | OTHER | TIN | 01 | GREAT WEST | OTHER | 2V3302 | 01 | CT | HEALTH NET | OTHER | 2120207 | 01 | CT | FIRST HEALTH / CCN | OTHER | 767457 | 01 | CT | CONNECTICARE | OTHER | TIN | 01 | WELLCARE | OTHER |