Provider Demographics
NPI:1235297250
Name:NIAKI, BIJAN NASSERI (MD)
Entity Type:Individual
Prefix:
First Name:BIJAN
Middle Name:NASSERI
Last Name:NIAKI
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 1:91 WASHINGTON STREET
Mailing Address - Street 2:3RD FLOOR STE 303
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780
Mailing Address - Country:US
Mailing Address - Phone:508-824-1259
Mailing Address - Fax:
Practice Address - Street 1:91 WASHINGTON STREET
Practice Address - Street 2:3RD FLOOR STE 303
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-824-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72033207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110052356AMedicaid
7497480OtherAETNA
MAAA181571OtherHARVARD PILGRIM
MA3103421Medicaid
MA3103421Medicaid
MA110052356AMedicaid