Provider Demographics
NPI:1093787483
Name:CHAOUI, AMIN (MD)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:
Last Name:CHAOUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CENTRE STREET
Mailing Address - Street 2:FAULKNER HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-983-7172
Mailing Address - Fax:617-983-7855
Practice Address - Street 1:1153 CENTRE STREET
Practice Address - Street 2:FAULKNER HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-983-7172
Practice Address - Fax:617-983-7855
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2054152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0114031Medicaid
MA205415OtherTUFTS
MAJ23094OtherBLUE CROSS BLUE SHIELD
MAA31587Medicare ID - Type Unspecified
MA0114031Medicaid