Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DL10743 | MA |
NPI | 1013140417 |
---|---|
Provider Name | Dr. Maha Ahmed Bahammam |
First Address | Malden, MA 02148-3909 |
Second Address | Malden, MA 02148-3909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |