Provider Demographics
NPI:1396731659
Name:TARAZI, NAKHLE A (MD)
Entity type:Individual
Prefix:
First Name:NAKHLE
Middle Name:A
Last Name:TARAZI
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 1:886 WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3466
Mailing Address - Country:US
Mailing Address - Phone:781-762-5542
Mailing Address - Fax:
Practice Address - Street 1:886 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3466
Practice Address - Country:US
Practice Address - Phone:781-762-5542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3115767Medicaid
E75841Medicare UPIN
MA3115767Medicaid