Provider Demographics
NPI:1114197845
Name:MAHMOUD KOWSARI MD INC
Entity type:Organization
Organization Name:MAHMOUD KOWSARI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOWSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-687-2225
Mailing Address - Street 1:50 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2841
Mailing Address - Country:US
Mailing Address - Phone:978-687-2225
Mailing Address - Fax:978-975-7508
Practice Address - Street 1:50 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2841
Practice Address - Country:US
Practice Address - Phone:978-687-2225
Practice Address - Fax:978-975-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM12001Medicare UPIN