Basic Information
| Provider Information | |||||||||
| NPI: | 1922386887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAKSHABANDI | ||||||||
| FirstName: | FIRAS | ||||||||
| MiddleName: | ABDUSSALAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 BELMONT ST BLDG 5 | ||||||||
| Address2: | (116A7) PSYCHIATRY EDUCATION ATTN: MARIE | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085834500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 940 BELMONT ST BLDG 5 | ||||||||
| Address2: | (116A7) PSYCHIATRY EDUCATION ATTN: MARIE | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023015596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085834500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 01/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 249139 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0804X | 036136493 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.