1871862656 NPI number — DR. MOHAMMAD HOSSEIN NIAYESH MD,FACS,FRCS

Table of content: DR. MOHAMMAD HOSSEIN NIAYESH MD,FACS,FRCS (NPI 1871862656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871862656 NPI number — DR. MOHAMMAD HOSSEIN NIAYESH MD,FACS,FRCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIAYESH
Provider First Name:
MOHAMMAD
Provider Middle Name:
HOSSEIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,FACS,FRCS
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:
1871862656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 SOMERSET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLINOCKET
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04462-1298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-723-7247
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 POPLAR ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLINOCKET
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04462-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-723-3003
Provider Business Practice Location Address Fax Number:
207-723-3006
Provider Enumeration Date:
12/22/2011

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: 208600000X , with the licence number:  018906 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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