Provider Demographics
NPI:1740409424
Name:SIRUS HAMZAVI, MD LLC PA
Entity Type:Organization
Organization Name:SIRUS HAMZAVI, MD LLC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-795-7517
Mailing Address - Street 1:10 HIGH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7640
Mailing Address - Country:US
Mailing Address - Phone:207-795-7517
Mailing Address - Fax:207-795-7523
Practice Address - Street 1:10 HIGH ST STE 304
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7640
Practice Address - Country:US
Practice Address - Phone:207-795-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016330207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0008791Medicare PIN