Provider Demographics
NPI:1164435186
Name:GHARIB, SOHEYLA D (MD)
Entity Type:Individual
Prefix:
First Name:SOHEYLA
Middle Name:D
Last Name:GHARIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HUHS
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-496-5804
Mailing Address - Fax:617-495-4879
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HUHS
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-496-5804
Practice Address - Fax:617-495-4879
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA47559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02706OtherBC/BS OF MA
MA445850OtherTUFTS HEALTH PLAN
MAD88322Medicare UPIN
MA445850OtherTUFTS HEALTH PLAN