Healthcare Provider Details

I. General information

NPI: 1831658731
Provider Name (Legal Business Name): TAREK HASSAAN MOUHIEDDINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5418
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-3000
  • Fax: 617-632-6624
Mailing address:
  • Phone: 617-632-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number1023488
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number1023488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: