Provider Demographics
NPI:1447367065
Name:SAHAKYAN, MARINE TOROSYAN (MD)
Entity type:Individual
Prefix:
First Name:MARINE
Middle Name:TOROSYAN
Last Name:SAHAKYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARINE
Other - Middle Name:T
Other - Last Name:SAHAKYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:345 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-561-7222
Mailing Address - Fax:860-561-7228
Practice Address - Street 1:345 NORTH MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:W HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-561-7222
Practice Address - Fax:860-561-7228
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040174207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001401744Medicaid
CT001401744Medicaid