Provider Demographics
NPI:1942396692
Name:MORADI, IRADJ (MD)
Entity Type:Individual
Prefix:MR
First Name:IRADJ
Middle Name:
Last Name:MORADI
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 1:140 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-820-9330
Mailing Address - Fax:508-879-3837
Practice Address - Street 1:140 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-820-9330
Practice Address - Fax:508-879-3837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2036096Medicaid
MA4525OtherFALLON SELECT & DIRECT
MA712359OtherTUFTS
MA8450OtherHARVARD PILGRIM
MAC05112OtherBLUE CROSS BLUE SHIELD
A38694Medicare UPIN
MA2036096Medicaid