Healthcare Provider Details

I. General information

NPI: 1477550622
Provider Name (Legal Business Name): RAED F TARAZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WRIGHT ST
PALMER MA
01069-1138
US

IV. Provider business mailing address

PO BOX 4023
SCOTTSDALE AZ
85261-4023
US

V. Phone/Fax

Practice location:
  • Phone: 413-370-5400
  • Fax: 413-284-5559
Mailing address:
  • Phone: 480-835-5302
  • Fax: 480-844-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34222
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number1024634
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: