Healthcare Provider Details

I. General information

NPI: 1639151574
Provider Name (Legal Business Name): HABIB A. SIOUFI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 UNION ST DEPARTMENT OF PATHOLOGY
MARLBOROUGH MA
01752-1228
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-486-5701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number50579
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: