Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 269210 | MA |
Y | 2080P0210X | Pediatric Nephrologist | 269210 | MA |
NPI | 1649362476 |
---|---|
Provider Name | Nasreen Azam |
First Address | Northampton, MA 01060-2052 |
Second Address | Northampton, MA 01060-2052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 23/12/2016 |