Provider Demographics
NPI:1174503825
Name:HAMZAVI, SIRUS (MD)
Entity Type:Individual
Prefix:MR
First Name:SIRUS
Middle Name:
Last Name:HAMZAVI
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 1:15 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2726
Mailing Address - Country:US
Mailing Address - Phone:207-774-8277
Mailing Address - Fax:207-871-1415
Practice Address - Street 1:15 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2726
Practice Address - Country:US
Practice Address - Phone:207-774-8277
Practice Address - Fax:207-871-1415
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016330207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEF85503Medicare UPIN
MEME031301Medicare PIN