Healthcare Provider Details

I. General information

NPI: 1174503825
Provider Name (Legal Business Name): SIRUS HAMZAVI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325A KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

IV. Provider business mailing address

325A KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2731
  • Fax:
Mailing address:
  • Phone: 207-873-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16330
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: