Provider Demographics
NPI:1205044153
Name:BIJAN SADRNOORI MD PC
Entity Type:Organization
Organization Name:BIJAN SADRNOORI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADRNOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-688-4665
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:STE 101
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5821
Mailing Address - Country:US
Mailing Address - Phone:978-688-4665
Mailing Address - Fax:978-682-8743
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:STE 101
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-688-4665
Practice Address - Fax:978-682-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41344207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3029051Medicaid
MAA67861Medicare ID - Type Unspecified
MAA67861Medicare UPIN