Provider Demographics
NPI:1073567749
Name:KHAJAVI-NOORI, FARROKH (MD)
Entity Type:Individual
Prefix:
First Name:FARROKH
Middle Name:
Last Name:KHAJAVI-NOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODLAND RD
Mailing Address - Street 2:#418
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1714
Mailing Address - Country:US
Mailing Address - Phone:781-662-6213
Mailing Address - Fax:781-665-9860
Practice Address - Street 1:3 WOODLAND RD STE 418
Practice Address - Street 2:STE 418
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1714
Practice Address - Country:US
Practice Address - Phone:781-662-6213
Practice Address - Fax:781-665-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2002019Medicaid
W65999Medicare UPIN
B40049Medicare ID - Type Unspecified