MEDICARE: DR. MORTEZA MOREY FARIZAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	039088	MA
2	2086S0129X	Vascular Surgery Physician	039088	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053374603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORTEZA MOREY FARIZAN M.D.

Provider Business Mailing Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	SETON MEDICAL BUILDING #209
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-298-0481
Fax Number	:	617-298-3358

Provider Business Practice Location Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	SETON MEDICAL BUILDING #209
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-298-0481
Fax Number	:	617-298-3358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/23/2016

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Directions to “ DR. MORTEZA MOREY FARIZAN M.D.” Practice Location

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