Provider Demographics
NPI:1083806053
Name:GOLPARIANI, MEHRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRAN
Middle Name:
Last Name:GOLPARIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 231233
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-0233
Mailing Address - Country:US
Mailing Address - Phone:631-474-2300
Mailing Address - Fax:631-474-2355
Practice Address - Street 1:59 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2628
Practice Address - Country:US
Practice Address - Phone:631-474-2300
Practice Address - Fax:631-474-2355
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192949207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG20755Medicare UPIN