Healthcare Provider Details

I. General information

NPI: 1811376130
Provider Name (Legal Business Name): AHMED MAKHLOUF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PORTER ST
BOSTON MA
02128-2116
US

IV. Provider business mailing address

14 PORTER ST
BOSTON MA
02128-2116
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-3189
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number277912
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA176038
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number62579
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: