Provider Demographics
NPI:1164521480
Name:RAHIM, IRFAN M (MD)
Entity Type:Individual
Prefix:
First Name:IRFAN
Middle Name:M
Last Name:RAHIM
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 1:77 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1684
Mailing Address - Country:US
Mailing Address - Phone:508-435-5506
Mailing Address - Fax:
Practice Address - Street 1:77 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1684
Practice Address - Country:US
Practice Address - Phone:508-435-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA204235OtherHARVARD PILGRIM
MA1267486002OtherCIGNA
MA12-03248OtherUNITED HEALTHCARE
MAJ24179OtherBLUE CROSS/BLUE SHIELD
MA210763OtherTUFTS
MA447466OtherHEALTHSOURCE(CMHC)
MA0180131Medicaid
MA210763OtherTUFTS