Provider Demographics
NPI:1396777835
Name:ALGUBLAN, NAWF H (MD)
Entity type:Individual
Prefix:
First Name:NAWF
Middle Name:H
Last Name:ALGUBLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAWF
Other - Middle Name:H
Other - Last Name:GOBLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 AVERY ST
Mailing Address - Street 2:APT 25G
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1002
Mailing Address - Country:US
Mailing Address - Phone:617-724-3874
Mailing Address - Fax:
Practice Address - Street 1:MGH
Practice Address - Street 2:55 FRUIT STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2123754Medicaid
MAJ40293OtherBLUE SHIELD