MEDICARE: MOHAMED AZZAM MEHSSEN MD

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
1	207R00000X	Internal Medicine Physician	80413	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080413	OTHER	MA	SECURE HORIZONS
2	J31736	OTHER	MA	BLUE CROSS
3	00000008291	OTHER	MA	BMC HEALTHNET
4	0002034	OTHER	MH	NEIGHBORHOOD HEALTH PLAN
5	080413	OTHER	MA	TUFTS HEALTH PLAN
6	04-02913	OTHER	MA	UNITED HEALTHCARE
7	65427UH	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1578536389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED AZZAM MEHSSEN MD

Provider Business Mailing Address
First Line	:	409 W BROADWAY
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-2245
Country	:	US
Telephone Number	:	617-269-7500
Fax Number	:	617-464-7512

Provider Business Practice Location Address
First Line	:	409 W BROADWAY
Second Line	:
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-2245
Country	:	US
Telephone Number	:	617-269-7500
Fax Number	:	617-464-7512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	02/03/2012

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Directions to “ MOHAMED AZZAM MEHSSEN MD” Practice Location

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