Basic Information
| Provider Information | |||||||||
| NPI: | 1982686549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHR | ||||||||
| FirstName: | MEHRDAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 WASHINGTON STREEY | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 BOSTON MEDICAL CTR PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174145170 | ||||||||
| FaxNumber: | 6174143803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 152593 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | 152593 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3186237 | 05 | MA | MEDICAID |