Provider Demographics
NPI:1457532194
Name:F KHAJAVI MD FACP INC
Entity Type:Organization
Organization Name:F KHAJAVI MD FACP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-662-6213
Mailing Address - Street 1:3 WOODLAND RD STE 418
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1714
Mailing Address - Country:US
Mailing Address - Phone:781-662-6213
Mailing Address - Fax:781-665-9860
Practice Address - Street 1:3 WOODLAND RD STE 418
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1714
Practice Address - Country:US
Practice Address - Phone:781-662-6213
Practice Address - Fax:781-665-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2002019Medicaid
MA2002019Medicaid
MAM12201Medicare PIN