Healthcare Provider Details

I. General information

NPI: 1730695941
Provider Name (Legal Business Name): RAZI O MIRSHAHI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 03/10/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

183 MOUNT AUBURN ST APT 46
WATERTOWN MA
02472-4012
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: