Provider Demographics
NPI:1962064162
Name:NOR, ABSHIR
Entity type:Individual
Prefix:
First Name:ABSHIR
Middle Name:
Last Name:NOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 NORTHAMPTON ST APT A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1833
Mailing Address - Country:US
Mailing Address - Phone:617-784-0703
Mailing Address - Fax:
Practice Address - Street 1:136 NORTHAMPTON ST APT A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1833
Practice Address - Country:US
Practice Address - Phone:617-784-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANAMedicaid