Provider Demographics
NPI:1780495572
Name:SHARIATI, MOHAMMAD JAVAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD JAVAD
Middle Name:
Last Name:SHARIATI
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 1:601 ALBANY ST UNIT 306
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2790
Mailing Address - Country:US
Mailing Address - Phone:617-784-6860
Mailing Address - Fax:
Practice Address - Street 1:660 S EUCLID AVE # 82332909
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-362-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program