Provider Demographics
NPI:1811994098
Name:GHAFGHAICHI, MEHRZAD (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRZAD
Middle Name:
Last Name:GHAFGHAICHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEHRZAD
Other - Middle Name:
Other - Last Name:PETROSINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2902 59TH ST W STE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7021
Mailing Address - Country:US
Mailing Address - Phone:941-794-5732
Mailing Address - Fax:
Practice Address - Street 1:2902 59TH ST W STE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7021
Practice Address - Country:US
Practice Address - Phone:941-794-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90030Medicare UPIN
FL26108ZMedicare ID - Type Unspecified