Provider Demographics
NPI:1881795730
Name:FAZEL, REZA (MD, MSC)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:FAZEL
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:185 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5324
Mailing Address - Country:US
Mailing Address - Phone:404-310-9722
Mailing Address - Fax:888-959-5133
Practice Address - Street 1:70 FRANCIS ST
Practice Address - Street 2:SH-5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6134
Practice Address - Country:US
Practice Address - Phone:857-307-1979
Practice Address - Fax:857-307-1955
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0931207RI0011X
VA0101260377207RI0011X
MA258103207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology