Healthcare Provider Details

I. General information

NPI: 1184356123
Provider Name (Legal Business Name): SINA FOROUTANJAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BOSTON POST RD W STE 200&202
MARLBOROUGH MA
01752-4667
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3310
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-9613
  • Fax: 978-371-0522
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1027343
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: