Provider Demographics
NPI:1881680544
Name:NEGAHBAN, KAMBIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:NEGAHBAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CAMBRIDGE PKWY
Mailing Address - Street 2:UNIT E1202
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 ROCHE BROTHERS WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:508-238-2388
Practice Address - Fax:508-238-2073
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212310207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA152683BMCOtherHARVARD PILGRIM HEALTH CA
MA2716088OtherAETNA
MAJ24253OtherBCBS
MA212310OtherTUFTS HEALTH PLAN
MA0151581Medicaid
MA0151581Medicaid
MAA33248Medicare ID - Type Unspecified
MAJ24253OtherBCBS