Provider Demographics
NPI:1922253657
Name:IRAJ AGHDASI, MD PC
Entity Type:Organization
Organization Name:IRAJ AGHDASI, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHDASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-331-8584
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1612
Mailing Address - Country:US
Mailing Address - Phone:781-331-8584
Mailing Address - Fax:
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:SUITE 24
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1612
Practice Address - Country:US
Practice Address - Phone:781-331-8584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39421207R00000X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty