Provider Demographics
NPI:1083091664
Name:AKBARI, MARYAM (DMD, MPH, MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:AKBARI
Suffix:
Gender:F
Credentials:DMD, MPH, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 EDGECLIFF RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3545
Mailing Address - Country:US
Mailing Address - Phone:617-866-8672
Mailing Address - Fax:
Practice Address - Street 1:49 EDGECLIFF RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3545
Practice Address - Country:US
Practice Address - Phone:617-866-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040260122300000X
NY0623091223S0112X
NY312294208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery