Individual
MISS BAHAREH EHSAEI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
(508) 894-0412
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5674
(508) 894-0400
(508) 894-0412
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101281893
VA
207R00000X
Internal Medicine Physician
Primary
332453
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2021
Last updated
04/05/2025
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