Provider Demographics
NPI:1619182714
Name:VAZIRI, ALIREZA
Entity type:Individual
Prefix:
First Name:ALIREZA
Middle Name:
Last Name:VAZIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CARDIOVASCULAR MEDICINE SUITE, 4TH FL MARGARET'S
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-562-7690
Practice Address - Fax:617-562-7699
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13726207R00000X, 208M00000X
LAMD.205756207R00000X
MA257321207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2149982Medicaid
NH30207669Medicaid
MS09026886Medicaid
ME432894399Medicaid
LA2314181Medicaid
NH30207669Medicaid
ME432894399Medicaid