Provider Demographics
NPI:1225525934
Name:MASOOD, KAMRAN (MD)
Entity type:Individual
Prefix:MR
First Name:KAMRAN
Middle Name:
Last Name:MASOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1817
Mailing Address - Country:US
Mailing Address - Phone:800-258-4674
Mailing Address - Fax:
Practice Address - Street 1:265 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1817
Practice Address - Country:US
Practice Address - Phone:800-258-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2024-07-17
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2019-02-06
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA10180712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program