1821330200 NPI number — DR. MARTA BRASCHI AMIRFARZAN M.D.

Table of content: DR. MARTA BRASCHI AMIRFARZAN M.D. (NPI 1821330200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821330200 NPI number — DR. MARTA BRASCHI AMIRFARZAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRASCHI AMIRFARZAN
Provider First Name:
MARTA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRASCHI
Provider Other First Name:
MARTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821330200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 BIRCH HILL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 MALL ROAD
Provider Second Line Business Practice Location Address:
LAHEY HOSPITAL AND MEDICAL CENTER
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-744-8170
Provider Business Practice Location Address Fax Number:
781-744-5232
Provider Enumeration Date:
03/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  270675 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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