Provider Demographics
NPI:1952948176
Name:JARIHI, ALIREZA
Entity Type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:JARIHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SHERI LN
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1551
Mailing Address - Country:US
Mailing Address - Phone:774-288-9964
Mailing Address - Fax:
Practice Address - Street 1:305 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1962
Practice Address - Country:US
Practice Address - Phone:774-288-9964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07121723363LP2300X
MARN2296737363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care