Provider Demographics
NPI:1922100064
Name:M. MOREY FARIZAN, M.D., P.C.
Entity Type:Organization
Organization Name:M. MOREY FARIZAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:MOREY
Authorized Official - Last Name:FARIZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-298-0481
Mailing Address - Street 1:2110 DORCHESTER AVE
Mailing Address - Street 2:#209
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5628
Mailing Address - Country:US
Mailing Address - Phone:617-298-0481
Mailing Address - Fax:617-298-3358
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:#209
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-298-0481
Practice Address - Fax:617-298-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2064863Medicaid
MAM12981Medicare ID - Type Unspecified