Provider Demographics
NPI:1689607103
Name:MAHDI, LAWRENCE FARID (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:FARID
Last Name:MAHDI
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 1:329 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3600
Mailing Address - Country:US
Mailing Address - Phone:973-748-3800
Mailing Address - Fax:973-748-3540
Practice Address - Street 1:329 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3600
Practice Address - Country:US
Practice Address - Phone:973-748-3800
Practice Address - Fax:973-748-3540
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04828100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223557137OtherBLUE SHIELD
NJ223557137OtherCOMMERCIAL INSURANCE
NJES442OtherOXFORD
NJ1879901Medicaid
NJOK7728OtherPHS
NJ060055314OtherRAILROAD MEDICARE
NJ18351OtherUS AETNA
NJOK7728OtherPHS