Provider Demographics
NPI:1497098610
Name:MODARAI, FARHAD (DO)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:MODARAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 E SQUANTUM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1253
Mailing Address - Country:US
Mailing Address - Phone:617-820-5968
Mailing Address - Fax:833-471-5603
Practice Address - Street 1:744 E SQUANTUM ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1253
Practice Address - Country:US
Practice Address - Phone:617-820-5968
Practice Address - Fax:833-471-5603
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00008207Q00000X
FLOS19085207Q00000X
IL036161281207Q00000X
TN3135207Q00000X
MA295461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine