Provider Demographics
NPI:1053374603
Name:FARIZAN, MORTEZA MOREY (MD)
Entity type:Individual
Prefix:DR
First Name:MORTEZA
Middle Name:MOREY
Last Name:FARIZAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2110 DORCHESTER AVE
Mailing Address - Street 2:SETON MEDICAL BUILDING #209
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5628
Mailing Address - Country:US
Mailing Address - Phone:617-298-0481
Mailing Address - Fax:617-298-3358
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SETON MEDICAL BUILDING #209
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-298-0481
Practice Address - Fax:617-298-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-02-23
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Provider Licenses
StateLicense IDTaxonomies
MA039088208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2064863Medicaid
MAA66895Medicare UPIN
MA2064863Medicaid