Provider Demographics
NPI:1053329730
Name:VAZIRI, SONYA M (MD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:M
Last Name:VAZIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-6050
Practice Address - Fax:617-421-6083
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA60693207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0016412OtherNEIGHBORHOOD HEALTH PLAN
MA060063675OtherMEDICARE RAILROAD
MA1661466-002OtherCIGNA
MAPM961OtherHARVARD PILGRIM
MA763624OtherTUFTS HEALTH PLAN
MAJ13512OtherBLUE CROSS
MA3106896Medicaid
MA060063675OtherMEDICARE RAILROAD
MAPM961OtherHARVARD PILGRIM