Individual provider · NPI-1
Benjamin Fakharzadeh, MM
Radiology, Diagnostic Radiology · Gardner, MA
NPI number1689801391
StatusActive
Last updated in NPPESFeb 14, 2018
Details
- NPI
- 1689801391
- Entity type
- Individual (NPI-1)
- Name
- Benjamin Fakharzadeh
- Credential
- MM
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 20, 2009
- Last updated
- Feb 14, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | 273798 | MA | Yes |
| 207R00000X | Internal Medicine | 241602 | MA |
Practice location
242 Green StGardner, MA 01440-1336
Phone 978-630-6235
Mailing address
2527 Cranberry HwyWareham, MA 02571-1046
Phone 800-841-5200 · Fax 508-273-1241
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