Healthcare Provider Details

I. General information

NPI: 1083935878
Provider Name (Legal Business Name): ALI BAGHIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number294342
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number294342
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number206611
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: