Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 253079 | MA |
NPI | 1093060642 |
---|---|
Provider Name | Dr. Mohamed Amir Mrad |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 16/11/2012 |