MEDICARE: EMAD ALSHWIAMI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	9577	MA

General Provider Information

NPI Number	:	1225291792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMAD ALSHWIAMI

Provider Business Mailing Address
First Line	:	8 9TH ST
Second Line	:	APT 604
City	:	MEDFORD
State	:	MA
Zip	:	02155-5176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5819
Country	:	US
Telephone Number	:	617-432-3967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2008
Last Update Date	:	07/05/2008

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