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General NPI Number Information
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NPI Number | 1922039478
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Entity Type | Individual
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Provider Name | FARIBORZ KHORSAND-RAVAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 88 WASHINGTON ST C/O MORTON HOSPITAL
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City | TAUNTON
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State | MA
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Zip | 02780-2465
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Country | US
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Telephone | 508-824-1280
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Fax | 508-824-7293
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Provider Business Mailing Address
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Address Line | 88 WASHINGTON ST C/O MORTON HOSPITAL
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City | TAUNTON
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State | MA
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Zip | 02780-2465
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Country | US
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Telephone | 508-824-1280
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Fax | 508-824-7293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD9948
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 75558
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License Number State | MA
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