Healthcare Provider Details

I. General information

NPI: 1750578506
Provider Name (Legal Business Name): FEYZA MAROUF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MOUNT VERNON ST
BOSTON MA
02108-1104
US

IV. Provider business mailing address

121 MOUNT VERNON ST
BOSTON MA
02108-1104
US

V. Phone/Fax

Practice location:
  • Phone: 617-676-7447
  • Fax:
Mailing address:
  • Phone: 617-676-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number236835
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: