Healthcare Provider Details

I. General information

NPI: 1962721738
Provider Name (Legal Business Name): BEHZAD GOHARFAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PIERCE AVE STE B
FITCHBURG MA
01420
US

IV. Provider business mailing address

133 LITTLETON RD STE 101
WESTFORD MA
01886-3198
US

V. Phone/Fax

Practice location:
  • Phone: 978-577-0437
  • Fax:
Mailing address:
  • Phone: 978-577-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54925
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number273699
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: