Provider Demographics
NPI:1184417941
Name:MUKHAMMADOV, TIMUR
Entity type:Individual
Prefix:MR
First Name:TIMUR
Middle Name:
Last Name:MUKHAMMADOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 KELTON ST APT 31
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4324
Mailing Address - Country:US
Mailing Address - Phone:646-318-7609
Mailing Address - Fax:
Practice Address - Street 1:165 KELTON ST APT 31
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-4324
Practice Address - Country:US
Practice Address - Phone:646-318-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program