Provider Demographics
NPI:1528473964
Name:HAROON, MUSTAFA (MD)
Entity type:Individual
Prefix:MR
First Name:MUSTAFA
Middle Name:
Last Name:HAROON
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 1:725 ALBANY ST
Mailing Address - Street 2:SHAPIRO 5 & 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2526
Mailing Address - Country:US
Mailing Address - Phone:617-414-5951
Mailing Address - Fax:617-414-9251
Practice Address - Street 1:1200 LOWER FAYETTEVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1133
Practice Address - Country:US
Practice Address - Phone:678-631-4610
Practice Address - Fax:678-631-4611
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259652207R00000X
GA85361207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine