Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 41712 | MA |
NPI | 1225029713 |
---|---|
Provider Name | Dr. Fuad B Mudawwar |
First Address | Northampton, MA 01062-2003 |
Second Address | Florence, MA 01062-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 13/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24219108 | (05) | MA |
A67016 | (02) |