Healthcare Provider Details

I. General information

NPI: 1760636518
Provider Name (Legal Business Name): HOUMAN AMIRFARZAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

59 BIRCH HILL RD
BELMONT MA
02478-1729
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-2000
  • Fax:
Mailing address:
  • Phone: 617-671-9137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number249403
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number232694
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number232694
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: