Provider Demographics
NPI:1831136845
Name:FARIVAR, MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:FARIVAR
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 1:886 WASHINGTON ST
Mailing Address - Street 2:MOHAMMAD FARIVAR, MD, PC
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:MOHAMMAD FARIVAR, MD, PC
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38815207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA038815OtherTUFTS HEALTH PLAN
MAM09050OtherBC/BS
MA30003OtherHARVARD PILGRIM HEALTH CARE
MA110119655OtherRAIL ROAD MEDICARE
MA30003OtherHARVARD PILGRIM HEALTH CA
MA110036254AMedicaid
MABX6075Medicare PIN
MA110036254AMedicaid