Healthcare Provider Details

I. General information

NPI: 1174581789
Provider Name (Legal Business Name): HUMAIRA A MAHMUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 BOLTON STREET KIDNEY & HYPERTENSION CLINIC INC.
MARLBOROUGH MA
01752
US

IV. Provider business mailing address

5 SAUNDERS RD
SUDBURY MA
01776-1282
US

V. Phone/Fax

Practice location:
  • Phone: 508-281-5953
  • Fax: 508-229-2343
Mailing address:
  • Phone: 508-281-5953
  • Fax: 508-229-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number154239
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: