Healthcare Provider Details

I. General information

NPI: 1871761023
Provider Name (Legal Business Name): MYRIAM LOUISE AZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VICTORY RD
QUINCY MA
02171-3139
US

IV. Provider business mailing address

44 RAECHEL RD
RANDOLPH MA
02368-3738
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-1040
  • Fax:
Mailing address:
  • Phone: 781-986-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: