Provider Demographics
NPI:1336985043
Name:KHAZAALI, MAHZIAR
Entity type:Individual
Prefix:
First Name:MAHZIAR
Middle Name:
Last Name:KHAZAALI
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 1:11 NEVINS ST STE 303
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-787-8181
Mailing Address - Fax:617-787-4644
Practice Address - Street 1:11 NEVINS ST STE 303
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-787-8181
Practice Address - Fax:617-787-4644
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3015876208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology