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General NPI Number Information
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NPI Number | 1790092203
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Entity Type | Organization
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Legal Business Name | BOSTON INTERVENTIONAL PAIN GROUP, PLLC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 14044 W CAMELBACK RD
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9428
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Country | US
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Telephone | 623-210-5156
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Fax | 623-218-9129
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Provider Business Mailing Address
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Address Line | 9524 W CAMELBACK RD SUITE 130 PMB#165
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City | GLENDALE
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State | AZ
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Zip | 85305-3104
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Country | US
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Telephone | 623-210-5156
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Fax | 623-218-9129
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Authorized Official
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Title or Position | MD
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Name | DR. ASHRAF FARID
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Credential | MD
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Telephone | 508-333-0449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 43561
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License Number State | AZ
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