Healthcare Provider Details

I. General information

NPI: 1073976932
Provider Name (Legal Business Name): AMIR MEHDIZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 SHREWSBURY ST STE 100
WORCESTER MA
01604-5465
US

IV. Provider business mailing address

119 BELMONT ST
WORCESTER MA
01605-2903
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-4861
  • Fax:
Mailing address:
  • Phone: 508-334-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number284019
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: