Provider Demographics
NPI:1871862656
Name:NIAYESH, MOHAMMAD HOSSEIN (MD,FACS,FRCS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:HOSSEIN
Last Name:NIAYESH
Suffix:
Gender:M
Credentials:MD,FACS,FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1298
Mailing Address - Country:US
Mailing Address - Phone:207-723-7247
Mailing Address - Fax:
Practice Address - Street 1:165 POPLAR ST STE 2
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1235
Practice Address - Country:US
Practice Address - Phone:207-723-3003
Practice Address - Fax:207-723-3006
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery