Provider Demographics
NPI:1629096623
Name:AFSHAR, MARYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:AFSHAR
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 1:850 HARRISON AVE
Mailing Address - Street 2:YACC BN-C7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-4001
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:860 HARRISON AVE
Practice Address - Street 2:DOWLING 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4002
Practice Address - Country:US
Practice Address - Phone:617-414-4238
Practice Address - Fax:617-414-5520
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2105732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0193160Medicaid
A33923Medicare ID - Type Unspecified
MA0193160Medicaid