Healthcare Provider Details

I. General information

NPI: 1922253657
Provider Name (Legal Business Name): IRAJ AGHDASI, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 MAIN ST SUITE 24
WEYMOUTH MA
02190-1612
US

IV. Provider business mailing address

851 MAIN ST SUITE 24
WEYMOUTH MA
02190-1612
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-8584
  • Fax:
Mailing address:
  • Phone: 781-331-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39421
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: IRAJ AGHDASI
Title or Position: OWNER
Credential: MD
Phone: 781-331-8584