Provider Demographics
NPI:1427759620
Name:AL BALUSHI, MUSTAFA MAHMOOD (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:MAHMOOD
Last Name:AL BALUSHI
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 1:1482 TREMONT ST APT W406
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2957
Mailing Address - Country:US
Mailing Address - Phone:617-505-2153
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST # 1-L2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-4332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program