Healthcare Provider Details

I. General information

NPI: 1134392491
Provider Name (Legal Business Name): OMAR ZURKIYA M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BROOKLINE AVE RADIOLOGY DEPARTMENT
BOSTON MA
02215-5403
US

IV. Provider business mailing address

300 BROOKLINE AVE RADIOLOGY DEPARTMENT
BOSTON MA
02215-5403
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number236188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: