Organization
AVANT-GARDE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARIBA MIRYOUSEFI (OWNER)
(508) 238-8646
Entity
Organization
Contact information
Practice address
62 PLEASANT ST, NATICK, MA 01760-5634
(508) 238-8646
Mailing address
35 UNITED DR STE 102, W BRIDGEWATER, MA 02379-1027
15082388646
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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