Healthcare Provider Details

I. General information

NPI: 1316964182
Provider Name (Legal Business Name): MAGDI M SOBEIH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE CH DEPARTMENT OF NEUROLOGY
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE FEGAN 11
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6388
  • Fax: 617-730-0284
Mailing address:
  • Phone: 617-355-2499
  • Fax: 617-730-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number209096
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: