Provider Demographics
NPI:1811961196
Name:DANESH, HAMID REZA (MD)
Entity type:Individual
Prefix:
First Name:HAMID
Middle Name:REZA
Last Name:DANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAMIDREZA
Other - Middle Name:
Other - Last Name:DANESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:585-597 MERRIMACK ST
Mailing Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-746-7778
Mailing Address - Fax:978-970-0359
Practice Address - Street 1:585 MERRIMACK ST
Practice Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-746-7778
Practice Address - Fax:978-970-0359
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
494257OtherTUFTS
3989627OtherAETNA
J29212OtherBLUE CROSS BLUE SHIELD
MAMX9720OtherMEDICARE PTAN
0036399OtherNEIGHBORHOOD HEALTH PLAN
MA13305557Medicaid
90957OtherFALLON
966127OtherNETWORK HEALTH
AA42182OtherHARVARD PILGRIM HEALTH CA
042881348OtherBEECH STREET
042881348OtherUNICARE
AA42182OtherHARVARD PILGRIM HEALTH CA
966127OtherNETWORK HEALTH