Provider Demographics
NPI:1740276765
Name:LOTFI, PARISA (MD)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:LOTFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:RADIOLOGY/BREAST IMAGING
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:RADIOLOGY/BREAST IMAGING
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2186142085R0202X
CT654482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA218614OtherTUFTS HEALTH CARE
MA2013886Medicaid
MAJ26505OtherBLUE CROSS BLUE SHIELD
MA245860OtherHARVARD PILGRIM
MDH37684Medicare UPIN
MAJ26505OtherBLUE CROSS BLUE SHIELD