Provider Demographics
NPI:1386712123
Name:SIMONIAN, NANCY ANN (MD)
Entity type:Individual
Prefix:
First Name:NANCY ANN
Middle Name:
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 OLD SUDBURY RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1808
Mailing Address - Country:US
Mailing Address - Phone:617-551-3612
Mailing Address - Fax:
Practice Address - Street 1:MILLENNIUM PHARMACEUTICALS
Practice Address - Street 2:40 LANDSDOWNE ST
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-551-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA760512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology