Provider Demographics
NPI:1386632206
Name:AZODI, MASOUD (MD)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:AZODI
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:PO BOX 205063
Mailing Address - Street 2:333 CEDAR STREET
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-5063
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:YALE PHYSICIANS BUILDING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-4176
Practice Address - Fax:203-785-5886
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034999207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001349994Medicaid
G29648Medicare UPIN
CT001349994Medicaid