1235124249 NPI number — HADIA FATIMA TIRMIZI M.D.

Table of content: HADIA FATIMA TIRMIZI M.D. (NPI 1235124249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235124249 NPI number — HADIA FATIMA TIRMIZI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIRMIZI
Provider First Name:
HADIA
Provider Middle Name:
FATIMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235124249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WARREN ST
Provider Second Line Business Mailing Address:
RM 339
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-562-5359
Provider Business Mailing Address Fax Number:
617-562-5415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 MOODY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-899-3334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  216111 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0188841 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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