Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 257625 | MA |
NPI | 1033379391 |
---|---|
Provider Name | Mostafa Noury |
First Address | Northborough, MA 01532-1909 |
Second Address | Northborough, MA 01532-1909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 10/06/2015 |