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NPI Code Detail

MEDICARE: DR. TARIK KALIL ALKASAB M.D., PH.D.

MEDICARE: DR. TARIK KALIL ALKASAB M.D., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician225952MA

General Provider Information

NPI Number : 1154305803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARIK KALIL ALKASAB M.D., PH.D.
Provider Business Mailing Address
First Line : 54 BREWSTER RD
Second Line :
City : SUDBURY
State : MA
Zip : 01776-2408
Country : US
Telephone Number : 978-443-6763
Fax Number :
Provider Business Practice Location Address
First Line : 2014 WASHINGTON ST
Second Line : DEPT OF MEDICAL EDUCATION
City : NEWTON
State : MA
Zip : 02462-1607
Country : US
Telephone Number : 617-243-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 07/26/2012

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