Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 216511 | MA |
N | 111NI0900X | Internist | 216511 | MA |
N | 207RA0201X | Internist - Allergy & Immunology | 216511 | MA |
N | 207RC0200X | Critical Care Medicine | 216511 | MA |
Y | 207RP1001X | Pulmonary Disease | 216511 | MA |
N | 207RS0012X | Sleep Medicine | #216511 | MA |
NPI | 1093704298 |
---|---|
Provider Name | Payam Aghassi |
First Address | Leominster, MA 01453 |
Second Address | Leominster, MA 01453-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 17/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2121247 | (05) | MA |
467556 | TUFTS (01) | |
9771476 | GROUP MEDICAID (01) | |
AA66577 | HARVARD PILGRIM (01) | |
I01847 | (02) | |
J27245 | BLUE CROSS IF MASS (01) | |
M20928 | GROUP MEDICARE (01) |