Provider Demographics
NPI:1154453256
Name:HOUTAN GOLZARI, MD
Entity type:Organization
Organization Name:HOUTAN GOLZARI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLZARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-576-1737
Mailing Address - Street 1:2355 BLACK ROCK TPKE
Mailing Address - Street 2:HOUTAN GOLZARI, MD
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3229
Mailing Address - Country:US
Mailing Address - Phone:203-576-1737
Mailing Address - Fax:203-334-3841
Practice Address - Street 1:2355 BLACK ROCK TPKE
Practice Address - Street 2:HOUTAN GOLZARI, MD
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3229
Practice Address - Country:US
Practice Address - Phone:203-576-1737
Practice Address - Fax:203-334-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02975Medicare ID - Type Unspecified