Provider Demographics
NPI:1629000112
Name:NOURI, MAHNAZ (MD)
Entity type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:
Last Name:NOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAMMOND POND PKWY
Mailing Address - Street 2:UNIT 505NORTH
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1533
Mailing Address - Country:US
Mailing Address - Phone:617-651-0938
Mailing Address - Fax:
Practice Address - Street 1:400 COMMONWEALTH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2813
Practice Address - Country:US
Practice Address - Phone:617-651-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH46749Medicare UPIN