Healthcare Provider Details

I. General information

NPI: 1093704298
Provider Name (Legal Business Name): PAYAM AGHASSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MEMORIAL DRIVE SUITE 113
LEOMINSTER MA
01453-2238
US

IV. Provider business mailing address

PO BOX 726
LEOMINSTER MA
01453
US

V. Phone/Fax

Practice location:
  • Phone: 978-466-2692
  • Fax: 978-466-4754
Mailing address:
  • Phone: 978-466-2692
  • Fax: 978-466-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number216511
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number216511
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number216511
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number216511
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number#216511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: