Healthcare Provider Details

I. General information

NPI: 1144684713
Provider Name (Legal Business Name): SUMMAIYA IQBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST ELIZABETH'S MEDICAL CENTER 736 CAMBRIDGE ST
BRIGHTON MA
02135-0001
US

IV. Provider business mailing address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2777
  • Fax:
Mailing address:
  • Phone: 617-789-2777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number275430
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: