Individual
LILY N PAYVANDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11 MELNEA CASS BLVD, BOSTON, MA 02119-4401
(617) 414-2080
(617) 414-2090
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
283291
MA
207Q00000X
Family Medicine Physician
MT213357
PA
2083C0008X
Clinical Informatics Physician
283291
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110163303A
—
MA
05
—
3138552
—
NH
Enumeration date
05/24/2017
Last updated
06/09/2023
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