MEDICARE: DR. BIJAN SADRNOORI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	41344	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639135650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIJAN SADRNOORI M.D.

Provider Business Mailing Address
First Line	:	411 MERRIMACK ST
Second Line	:	SUITE 101
City	:	METHUEN
State	:	MA
Zip	:	01844-5821
Country	:	US
Telephone Number	:	978-688-4665
Fax Number	:	978-682-8743

Provider Business Practice Location Address
First Line	:	411 MERRIMACK ST
Second Line	:	SUITE 101
City	:	METHUEN
State	:	MA
Zip	:	01844-5821
Country	:	US
Telephone Number	:	978-688-4665
Fax Number	:	978-682-8743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2008

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