Provider Demographics
NPI:1609808138
Name:MIRYOUSEFI, FARIBA (MD)
Entity Type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:MIRYOUSEFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WASHINGTON ST
Mailing Address - Street 2:ESSEX INPATIENT PHYSICIANS
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-1017
Mailing Address - Country:US
Mailing Address - Phone:978-296-3781
Mailing Address - Fax:978-296-3783
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:ESSEX INPATIENT PHYSICIANS
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1017
Practice Address - Country:US
Practice Address - Phone:978-296-3781
Practice Address - Fax:978-296-3783
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226868207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine