1902865322 NPI number — FEREYDOUN SHAHROKHI MD

Table of content: FEREYDOUN SHAHROKHI MD (NPI 1902865322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902865322 NPI number — FEREYDOUN SHAHROKHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAHROKHI
Provider First Name:
FEREYDOUN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902865322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WOODLAND ROAD
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
STONEHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-662-9001
Provider Business Mailing Address Fax Number:
781-662-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WOODLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
STONEHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-662-9001
Provider Business Practice Location Address Fax Number:
781-662-3888
Provider Enumeration Date:
03/23/2006

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: 2084N0400X , with the licence number:  039030 , 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)

  • Identifier: 0500056 . This is a "UNITED HEALTH WARWICK RI" identifier . This identifiers is of the category "OTHER".
  • Identifier: S009876 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140589 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 039030 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29151 . This is a "AETNA US HLTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: B20546401 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11902 . This is a "HARVARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95270 . This is a "EMPIRE BC BS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com