Healthcare Provider Details

I. General information

NPI: 1295082477
Provider Name (Legal Business Name): SANAM LATHIEF M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE STE 3300
CAMBRIDGE MA
02138-1055
US

IV. Provider business mailing address

725 CONCORD AVE STE 6100
CAMBRIDGE MA
02138-1040
US

V. Phone/Fax

Practice location:
  • Phone: 617-864-8822
  • Fax: 617-354-1318
Mailing address:
  • Phone: 617-864-8822
  • Fax: 617-354-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15691
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number285707
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: