Healthcare Provider Details

I. General information

NPI: 1154637403
Provider Name (Legal Business Name): ARSHYA B. VAHABZADEH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MGH/HARVARD
BOSTON MA
02114
US

IV. Provider business mailing address

139A CHARLES ST STE 222
BOSTON MA
02114-3252
US

V. Phone/Fax

Practice location:
  • Phone: 404-857-7179
  • Fax:
Mailing address:
  • Phone: 404-857-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number254486
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA135155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: