Provider Demographics
NPI:1487124301
Name:LABIB, MAHMOUD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:LABIB
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:BETH ISRAEL DEACONESS MEDICAL CENTER
Mailing Address - Street 2:330 BROOKLINE AVE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-3110
Mailing Address - Fax:617-667-5050
Practice Address - Street 1:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - Street 2:330 BROOKLINE AVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-3110
Practice Address - Fax:617-667-5050
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-10-30
Deactivation Date:2019-07-19
Deactivation Code:
Reactivation Date:2020-02-13
Provider Licenses
StateLicense IDTaxonomies
MA278214207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology