Provider Demographics
NPI:1124602123
Name:THOMPSON-MASSOOM, SAMEER
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:THOMPSON-MASSOOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1737
Mailing Address - Country:US
Mailing Address - Phone:781-267-2170
Mailing Address - Fax:
Practice Address - Street 1:80 NEPTUNE BLVD
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4570
Practice Address - Country:US
Practice Address - Phone:781-477-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program