Healthcare Provider Details

I. General information

NPI: 1386609907
Provider Name (Legal Business Name): FATHALLA MASHALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONVERSE PL SUITE 4
WINCHESTER MA
01890-2713
US

IV. Provider business mailing address

10 CONVERSE PL SUITE 4
WINCHESTER MA
01890-2713
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-0500
  • Fax: 781-729-0581
Mailing address:
  • Phone: 781-729-0500
  • Fax: 781-729-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number152670
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD09332
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number152670
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD09332
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: