Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2015014044 | MO |
N | 111NI0900X | Internist | 2015014044 | MO |
N | 207R00000X | Internist | 276951 | MA |
N | 111NI0900X | Internist | 276951 | MA |
NPI | 1003291279 |
---|---|
Provider Name | Fadel Bofarrag |
First Address | Tamarac, FL 33321-6424 |
Second Address | Melrose, MA 02176-3225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2015 |
Last Update Date | 02/02/2021 |