Provider Demographics
NPI:1679684534
Name:MOHAMMAD FARIVAR, MD, PC
Entity Type:Organization
Organization Name:MOHAMMAD FARIVAR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-762-3200
Mailing Address - Street 1:886 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3466
Mailing Address - Country:US
Mailing Address - Phone:781-762-3200
Mailing Address - Fax:781-769-7797
Practice Address - Street 1:886 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3466
Practice Address - Country:US
Practice Address - Phone:781-762-3200
Practice Address - Fax:781-769-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA608605OtherTUFTS HEALTH PLAN
DG8734OtherRAILROAD MEDICARE
MA30003OtherHARVARD PILGRIM HEALTH CARE
MA110072341AMedicaid
MAM16389OtherBC/BS
MAM16389OtherBC/BS