Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MT190346 | PA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 258521 | NY |
NPI | 1689841488 |
---|---|
Provider Name | Dr. Mohammadreza Azadfard |
First Address | Amherst, NY 14228-2783 |
Second Address | Amherst, NY 14228-2783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03292197 | (05) | NY |