Provider Demographics
NPI:1154573657
Name:M EHSAN QADIR MD LLC
Entity type:Organization
Organization Name:M EHSAN QADIR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-732-1677
Mailing Address - Street 1:22 WESTFIELD AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001251644Medicaid
CTD76972Medicare UPIN
CT110001155Medicare PIN