Provider Demographics
NPI:1902865322
Name:SHAHROKHI, FEREYDOUN (MD)
Entity Type:Individual
Prefix:
First Name:FEREYDOUN
Middle Name:
Last Name:SHAHROKHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 WOODLAND ROAD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:781-662-9001
Mailing Address - Fax:781-662-3888
Practice Address - Street 1:3 WOODLAND ROAD
Practice Address - Street 2:SUITE #200
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-662-9001
Practice Address - Fax:781-662-3888
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0390302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500056OtherUNITED HEALTH WARWICK RI
S009876OtherCHAMPUS
MA0140589Medicaid
039030OtherTUFTS
29151OtherAETNA US HLTH
B20546401OtherCIGNA
11902OtherHARVARD
95270OtherEMPIRE BC BS
S009876OtherCHAMPUS
0500056OtherUNITED HEALTH WARWICK RI