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NPI Code Detail

MEDICARE: DR. MOHAMMADREZA AZADFARD MD

MEDICARE: DR. MOHAMMADREZA AZADFARD MD
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
1207Q00000XFamily Medicine PhysicianMT190346PA
2207QA0401XAddiction Medicine (Family Medicine) Physician258521NY

Other Identifiers

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

General Provider Information

NPI Number : 1689841488
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMMADREZA AZADFARD MD
Provider Business Mailing Address
First Line : 100 KINGS HWY S
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-5504
Country : US
Telephone Number : 855-922-1203
Fax Number :
Provider Business Practice Location Address
First Line : 16 BANK ST FL 2
Second Line :
City : BATAVIA
State : NY
Zip : 14020-2250
Country : US
Telephone Number : 585-344-7276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2008
Last Update Date : 06/29/2023

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