Healthcare Provider Details

I. General information

NPI: 1922039478
Provider Name (Legal Business Name): FARIBORZ KHORSAND-RAVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST C/O MORTON HOSPITAL
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

88 WASHINGTON ST C/O MORTON HOSPITAL
TAUNTON MA
02780-2465
US

V. Phone/Fax

Practice location:
  • Phone: 508-824-1280
  • Fax: 508-824-7293
Mailing address:
  • Phone: 508-824-1280
  • Fax: 508-824-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD9948
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number75558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: