Provider Demographics
NPI:1578531505
Name:KEROUZ, NADA (MD)
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:KEROUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST
Mailing Address - Street 2:SUITE301
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-721-3581
Mailing Address - Fax:781-721-3580
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1961
Practice Address - Country:US
Practice Address - Phone:781-721-3581
Practice Address - Fax:781-721-3580
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77272207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF25143Medicare UPIN
MAA21417Medicare ID - Type Unspecified