Provider Demographics
NPI:1669459152
Name:SAFAVI, ROKNEDIN (MD)
Entity Type:Individual
Prefix:
First Name:ROKNEDIN
Middle Name:
Last Name:SAFAVI
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:CENTER FOR HEALTHY AGING
Mailing Address - Street 2:480 MAPLE ST. SUITE 201
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-646-7070
Mailing Address - Fax:978-750-6988
Practice Address - Street 1:CENTER FOR HEALTHY AGING
Practice Address - Street 2:480 MAPLE ST. SUITE 201
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-646-7070
Practice Address - Fax:978-750-6988
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC552142084P0800X
MA2741602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34148208500OtherBWC
OH0510012Medicaid
OH34148208500OtherBWC
B77568Medicare UPIN