Healthcare Provider Details

I. General information

NPI: 1669363024
Provider Name (Legal Business Name): FADHEL MEERZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 TRAPELO RD
BELMONT MA
02478-1849
US

IV. Provider business mailing address

201 CONCORD TPKE APT 2426
CAMBRIDGE MA
02140-2783
US

V. Phone/Fax

Practice location:
  • Phone: 617-758-8454
  • Fax:
Mailing address:
  • Phone: 617-201-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1000796
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: