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General NPI Number Information
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NPI Number | 1255319430
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Entity Type | Individual
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Provider Name | MARIANNE KHOURY M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 485 ARSENAL ST
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City | WATERTOWN
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State | MA
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Zip | 02472-5091
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Country | US
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Telephone | 617-972-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 147 MILK ST PROVIDER ENROLLMENT - 9TH FLOOR
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City | BOSTON
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State | MA
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Zip | 02109-4806
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Country | US
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Telephone | 617-559-8239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 161256
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License Number State | MA
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