Healthcare Provider Details

I. General information

NPI: 1780639203
Provider Name (Legal Business Name): MEHRAN SHAHSAVARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WOBURN STREET, SUITE 14
NORTH READING MA
01864
US

IV. Provider business mailing address

36 WOBURN STREET, SUITE 14
NORTH READING MA
01864
US

V. Phone/Fax

Practice location:
  • Phone: 781-944-1024
  • Fax:
Mailing address:
  • Phone: 781-944-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number41987
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: