Healthcare Provider Details

I. General information

NPI: 1700806635
Provider Name (Legal Business Name): JUMAN CAROL HIJAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

940 BELMONT ST
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-7700
  • Fax:
Mailing address:
  • Phone: 508-583-4500
  • Fax: 774-826-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76841
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number76841
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: