Healthcare Provider Details

I. General information

NPI: 1104847003
Provider Name (Legal Business Name): PEDRAM PARVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

57 ELIOT ST APT 26
JAMAICA PLAIN MA
02130-2700
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6448
  • Fax:
Mailing address:
  • Phone: 504-442-1600
  • Fax: 857-203-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number36355
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number234159
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: