Healthcare Provider Details

I. General information

NPI: 1194632794
Provider Name (Legal Business Name): MUTASIM MAHDI ELFAHAL PHD, DABCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-0002
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0002
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-1278
  • Fax: 781-744-5208
Mailing address:
  • Phone: 781-744-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: