Provider Demographics
NPI:1669959227
Name:MASOUD, TAMMER (MD)
Entity type:Individual
Prefix:
First Name:TAMMER
Middle Name:
Last Name:MASOUD
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 1:279 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2120
Mailing Address - Country:US
Mailing Address - Phone:508-334-8830
Mailing Address - Fax:508-334-8810
Practice Address - Street 1:279 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-334-8830
Practice Address - Fax:508-334-8810
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program