Healthcare Provider Details

I. General information

NPI: 1790714400
Provider Name (Legal Business Name): AMIR S LOTFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7246
  • Fax: 413-794-0198
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number213778
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number213778
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2129256
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
IdentifierJ40515
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS/BLUE SHIELD OF MA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: