Provider Demographics
NPI:1558333120
Name:JALALI, MAZDA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZDA
Middle Name:
Last Name:JALALI
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 1:72 HIGHLAND AVE
Mailing Address - Street 2:PEDIATRIC ASSOCIATES OF GREATER SALEM
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2738
Mailing Address - Country:US
Mailing Address - Phone:978-745-3050
Mailing Address - Fax:978-744-9594
Practice Address - Street 1:72 HIGHLAND AVE
Practice Address - Street 2:PEDIATRIC ASSOCIATES OF GREATER SALEM
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2738
Practice Address - Country:US
Practice Address - Phone:978-745-3050
Practice Address - Fax:978-744-9594
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
470038OtherTU
J28341OtherBS