Individual
AHMAD FOTOVAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 TECHNOLOGY DR, C-100, TRUMBULL, CT 06611-1395
(203) 268-5212
(203) 268-6779
Mailing address
115 TECHNOLOGY DR, C-100, TRUMBULL, CT 06611-6337
(203) 268-5212
(203) 268-6779
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
022045
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010022045CT04
ANTHEM BC/BS
CT
01
—
103685
BETTER HEALTH ADVANTAGE
CT
01
—
1176502
AETNA - HMO
CT
01
—
2V5317
HEALTH NET
CT
01
—
4395958
CIGNA
CT
01
—
4662047
AETNA - PPO
CT
01
—
512H41
EMPIRE BC/BS
CT
01
—
796029
CONNECTICARE
CT
01
—
ZS080
OXFORD HEALTH PLANS
CT
Enumeration date
05/20/2006
Last updated
10/10/2007
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