Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 249477 | MA |
N | 207YS0123X | Facial Plastic Surgeon | 249477 | MA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 249477 | MA |
NPI | 1821118837 |
---|---|
Provider Name | Dr. Waleed Hazem Ezzat |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02118-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2007 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0A1130100 | (05) | CA |
110090218A | (05) | MA |