Healthcare Provider Details

I. General information

NPI: 1588774459
Provider Name (Legal Business Name): NAWAL NOUR MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST CWN3 BRIGHAM & WOMENS HOSPITAL DIV MATERNAL FETAL MED
BOSTON MA
02115
US

IV. Provider business mailing address

75 FRANCIS ST CWN3 BRIGHAM & WOMENS HOSPITAL DIV MATERNAL FETAL MED
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8181
  • Fax:
Mailing address:
  • Phone: 617-732-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number157273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: