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NPI Code Detail

MEDICARE: MARIANNE KHOURY M.D.

MEDICARE: MARIANNE KHOURY M.D.
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
1208000000XPediatrics Physician161256MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10025243OTHERMANEIGHBORHOOD HEALTH
2J24349OTHERMABLUE CROSS
3HV0128OTHERMAHARVARD PILGRIM
4161256OTHERMATUFTS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255319430
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNE KHOURY M.D.
Provider Business Mailing Address
First Line : 147 MILK ST
Second Line : PROVIDER ENROLLMENT - 9TH FLOOR
City : BOSTON
State : MA
Zip : 02109-4806
Country : US
Telephone Number : 617-559-8239
Fax Number :
Provider Business Practice Location Address
First Line : 485 ARSENAL ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number : 617-972-5570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 02/07/2012

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