Provider Demographics
NPI:1861886681
Name:SALARI, BIJAN
Entity type:Individual
Prefix:
First Name:BIJAN
Middle Name:
Last Name:SALARI
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 1:339 CEDAR ST.
Mailing Address - Street 2:
Mailing Address - City:W. BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668
Mailing Address - Country:US
Mailing Address - Phone:419-787-4414
Mailing Address - Fax:
Practice Address - Street 1:51 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3109
Practice Address - Country:US
Practice Address - Phone:508-957-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA286403208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program