Healthcare Provider Details

I. General information

NPI: 1922367861
Provider Name (Legal Business Name): ARMIN MAGHSOUDLOU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2012
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 E CONCORD ST EVANS 124
BOSTON MA
02118-2307
US

IV. Provider business mailing address

72 E CONCORD ST EVANS 124
BOSTON MA
02118-2307
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6513
  • Fax: 617-638-6501
Mailing address:
  • Phone: 617-638-6513
  • Fax: 617-638-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number293464
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number293464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: