MEDICARE: DAVID FARZAN MD

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	207Q00000X	Family Medicine Physician	74355	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080165006	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	E91732	OTHER	NH	ANTHEM BLUE CROSS
5	975494	OTHER		NETWORK HEALTH
6	4221511	OTHER		CIGNA HEALTHCARE
7	91532	OTHER		HEALTHSOURCE
8	01-00557	OTHER		EVERCARE
9	J11639	OTHER	MA	BLUE CROSS BLUE SHIELD
10	0016298	OTHER		NEIGHBORHOOD HEALTH PLAN
11	074355	OTHER	MA	TUFTS HEALTH PLAN
12	70293	OTHER	MA	HARVARD PILGRIM HEALTH CA

General Provider Information

NPI Number	:	1093719924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID FARZAN MD

Provider Business Mailing Address
First Line	:	25 MARSTON ST
Second Line	:	3RD FL
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2310
Country	:	US
Telephone Number	:	978-688-3100
Fax Number	:	978-557-8633

Provider Business Practice Location Address
First Line	:	25 MARSTON ST
Second Line	:	3RD FL
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2310
Country	:	US
Telephone Number	:	978-688-3100
Fax Number	:	978-557-8633

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/11/2011

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Practice Location Address:

25 MARSTON ST FL 3
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01841-2310

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1306844220 — DRASKO SIMOVIC MD
Practice Location Address:

25 MARSTON ST , SUITE 208
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01841-2310

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1336148618 — THEODORE GAVRILESCU MD
Practice Location Address:

25 MARSTON ST , SUITE 208
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1326021429 — PEDRO M SANZ-ALTAMIRA M.D.
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25 MARSTON ST , SUITE #301
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1861472987 — VIDAL PRIMITERIO PA
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25 MARSTON ST , SUITE 105
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Directions to “ DAVID FARZAN MD” Practice Location

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