Healthcare Provider Details

I. General information

NPI: 1659293876
Provider Name (Legal Business Name): OMAR TAHOUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

20 CHAPEL ST APT A311
BROOKLINE MA
02446-7417
US

V. Phone/Fax

Practice location:
  • Phone: 617-919-7226
  • Fax:
Mailing address:
  • Phone: 617-959-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number3019937
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3019937
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: