Healthcare Provider Details

I. General information

NPI: 1659318756
Provider Name (Legal Business Name): FATHYEH F MARVASTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 BOSTON RD
NORTH BILLERICA MA
01862-2310
US

IV. Provider business mailing address

267 BOSTON RD
NORTH BILLERICA MA
01862-2310
US

V. Phone/Fax

Practice location:
  • Phone: 978-663-6666
  • Fax:
Mailing address:
  • Phone: 978-663-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81691
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: