Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 074439 | GA |
Y | 208200000X | Surgeon | 290089 | MA |
Y | 208600000X | Surgeon | 290089 | MA |
NPI | 1235302415 |
---|---|
Provider Name | Dr. Marwan Mujid Kazimi |
First Address | Boston, MA 02215-5501 |
Second Address | Boston, MA 02215-5501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BK9975876 | DEA (01) | MA |