Individual
JABBAR FAZELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 W COLE RD STE 101, BIDDEFORD, ME 04005-9431
(207) 780-6565
Mailing address
22 W COLE RD STE 101, BIDDEFORD, ME 04005-9431
(207) 780-6565
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
015513
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227900099
—
ME
Enumeration date
10/02/2006
Last updated
10/15/2021
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