Provider Demographics
NPI:1992110415
Name:JAVADY, HOUMAN J (MD)
Entity type:Individual
Prefix:
First Name:HOUMAN
Middle Name:J
Last Name:JAVADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOUMAN
Other - Middle Name:
Other - Last Name:HAJI SEYEDJAVADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:123 SUMMER ST STE 220S
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-368-3122
Mailing Address - Fax:508-368-3123
Practice Address - Street 1:123 SUMMER ST STE 220S
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3122
Practice Address - Fax:508-368-3123
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15920207R00000X
MA273169207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110123828AMedicaid