Provider Demographics
NPI:1093719924
Name:FARZAN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FARZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25 MARSTON ST
Mailing Address - Street 2:3RD FL
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2310
Mailing Address - Country:US
Mailing Address - Phone:978-688-3100
Mailing Address - Fax:978-557-8633
Practice Address - Street 1:25 MARSTON ST
Practice Address - Street 2:3RD FL
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2310
Practice Address - Country:US
Practice Address - Phone:978-688-3100
Practice Address - Fax:978-557-8633
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-02-11
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Provider Licenses
StateLicense IDTaxonomies
MA74355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080165006OtherRAILROAD MEDICARE
NH30008989OtherNH MEDICAID
MA3086054Medicaid
NHE91732OtherANTHEM BLUE CROSS
975494OtherNETWORK HEALTH
4221511OtherCIGNA HEALTHCARE
91532OtherHEALTHSOURCE
01-00557OtherEVERCARE
MAJ11639OtherBLUE CROSS BLUE SHIELD
0016298OtherNEIGHBORHOOD HEALTH PLAN
MA074355OtherTUFTS HEALTH PLAN
MA70293OtherHARVARD PILGRIM HEALTH CA
MA70293OtherHARVARD PILGRIM HEALTH CA
MAE91732Medicare UPIN