| Ahmad Fotovat, MD | |
| 
					115 Technology Dr, C-100, Trumbull, CT 06611-1395  | |
| (203) 268-5212 | |
| (203) 268-6779 | 
| Full Name | Ahmad Fotovat | 
|---|---|
| Gender | Male | 
| Speciality | Surgery | 
| Location | 115 Technology Dr, Trumbull, Connecticut | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1740234178 | NPI | - | NPPES | 
| 4395958 | Other | CT | CIGNA | 
| 512H41 | Other | CT | EMPIRE BC/BS | 
| 1176502 | Other | CT | AETNA - HMO | 
| 2V5317 | Other | CT | HEALTH NET | 
| 796029 | Other | CT | CONNECTICARE | 
| 4662047 | Other | CT | AETNA - PPO | 
| 010022045CT04 | Other | CT | ANTHEM BC/BS | 
| 103685 | Other | CT | BETTER HEALTH ADVANTAGE | 
| ZS080 | Other | CT | OXFORD HEALTH PLANS | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208600000X | Surgery | 022045 (Connecticut) | Primary | 
| Entity Name | St. Vincent's Multispecialty Group Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1043544489 PECOS PAC ID: 6204977218 Enrollment ID: O20100112000538  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ahmad Fotovat, MD 115 Technology Dr, C-100, Trumbull, CT 06611-6337 Ph: (203) 268-5212  | Ahmad Fotovat, MD 115 Technology Dr, C-100, Trumbull, CT 06611-1395 Ph: (203) 268-5212  | 
Noah Solomon Kinstlinger, M.D. Surgery Medicare: Medicare Enrolled Practice Location: 112 Quarry Rd, Trumbull, CT 06611 Phone: 203-785-2561  | |
Shareef Jandali, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 5520 Park Ave, Suite Wp-2-300, Trumbull, CT 06611 Phone: 203-374-0310 Fax: 203-374-0314  | |
Daniel J Passeri, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 888 White Plains Rd, Suite 206, Trumbull, CT 06611 Phone: 203-459-8555 Fax: 203-459-2666  | |
Timothy B Ehrlich Ii, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 115 Technology Drive, Suite C100, Trumbull, CT 06611 Phone: 203-899-0744 Fax: 203-268-6779  | |
Melanie A Lynch, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 5520 Park Ave Ste 1-500, Trumbull, CT 06611 Phone: 203-254-2381 Fax: 203-337-8788  |