Provider Demographics
NPI:1720192800
Name:FALLAH SOHY, ESMAIL (MD)
Entity Type:Individual
Prefix:
First Name:ESMAIL
Middle Name:
Last Name:FALLAH SOHY
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 1:95 CHAPEL STREET
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3161
Mailing Address - Country:US
Mailing Address - Phone:781-769-8769
Mailing Address - Fax:781-769-9688
Practice Address - Street 1:95 CHAPEL STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3161
Practice Address - Country:US
Practice Address - Phone:781-769-8769
Practice Address - Fax:781-769-9688
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA712931OtherTUFT
MA3028836Medicaid
MA3150OtherHPH
MA3028836Medicaid
MAB98088Medicare UPIN