Provider Demographics
NPI:1639135650
Name:SADRNOORI, BIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:SADRNOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5821
Mailing Address - Country:US
Mailing Address - Phone:978-688-4665
Mailing Address - Fax:978-682-8743
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-688-4665
Practice Address - Fax:978-682-8743
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA41344207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3029051Medicaid
MAA67861Medicare UPIN
MA3029051Medicaid