Provider Demographics
NPI:1689836868
Name:NEZHAD, ALIREZA H (MD)
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:H
Last Name:NEZHAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALIREZA
Other - Middle Name:
Other - Last Name:HOSSEINNEZHAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:508-764-2432
Practice Address - Street 1:25 LIBBY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2949
Practice Address - Country:US
Practice Address - Phone:508-941-7700
Practice Address - Fax:508-941-6334
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA245924207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine