MEDICARE: HABIB A. SIOUFI 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	50579	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639151574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HABIB A. SIOUFI MD

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 UNION ST
Second Line	:	DEPARTMENT OF PATHOLOGY
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1228
Country	:	US
Telephone Number	:	508-486-5701
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	11/04/2010

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