Healthcare Provider Details

I. General information

NPI: 1932021771
Provider Name (Legal Business Name): BADER ALHARBI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 LONGWOOD AVE
BOSTON MA
02115-5804
US

IV. Provider business mailing address

200 BROOKLINE AVE
BOSTON MA
02215-3912
US

V. Phone/Fax

Practice location:
  • Phone: 201-401-5378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3019936
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: