Provider Demographics
NPI:1023452927
Name:BEN GHORBAL, SARRA
Entity type:Individual
Prefix:
First Name:SARRA
Middle Name:
Last Name:BEN GHORBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3417
Mailing Address - Country:US
Mailing Address - Phone:646-306-9243
Mailing Address - Fax:
Practice Address - Street 1:1249 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3417
Practice Address - Country:US
Practice Address - Phone:617-264-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH68344183500000X
MAPH236613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042312909OtherBRIGHAM AND WOMEN HOSPITAL