Provider Demographics
NPI:1437219623
Name:TAUNTON REGIONAL PAIN MEDICINE CENTER, INC
Entity Type:Organization
Organization Name:TAUNTON REGIONAL PAIN MEDICINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:NASSERI
Authorized Official - Last Name:NIAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-222-2718
Mailing Address - Street 1:1 WASHINGTON ST UNIT 400
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:774-222-2718
Mailing Address - Fax:
Practice Address - Street 1:91 WASHINGTON ST
Practice Address - Street 2:SUIT 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:508-824-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9761870Medicaid
MAM21761Medicare PIN