Healthcare Provider Details

I. General information

NPI: 1639600158
Provider Name (Legal Business Name): MICHAEL REZAEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST BLDG WEST
CONCORD NH
03301-2548
US

IV. Provider business mailing address

250 PLEASANT ST
CONCORD NH
03301-2598
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3388
  • Fax:
Mailing address:
  • Phone: 603-227-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number31000
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0093786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: