Provider Demographics
NPI:1659318756
Name:MARVASTI, FATHYEH F (MD)
Entity Type:Individual
Prefix:
First Name:FATHYEH
Middle Name:F
Last Name:MARVASTI
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 1:267 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01862-2310
Mailing Address - Country:US
Mailing Address - Phone:978-663-6666
Mailing Address - Fax:
Practice Address - Street 1:267 BOSTON RD
Practice Address - Street 2:
Practice Address - City:NORTH BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01862-2310
Practice Address - Country:US
Practice Address - Phone:978-663-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine