Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 48377 | MA |
Y | 2084N0402X | Child Neurologist | 48377 | MA |
NPI | 1093748360 |
---|---|
Provider Name | Dr. Rizkalla A. Mouchati |
First Address | Quincy, MA 02169-0908 |
Second Address | Quincy, MA 02169-0908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 11/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3012336 | (05) | MA |