Basic Information
Provider Information
NPI: 1033559166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABOELKHEIR
FirstName: USAMA
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 736 CAMBRIDGE ST
Address2: SMC8
City: BOSTON
State: MA
PostalCode: 021352907
CountryCode: US
TelephoneNumber: 6177895004
FaxNumber: 6177796481
Practice Location
Address1: 736 CAMBRIDGE ST
Address2: SMC8
City: BOSTON
State: MA
PostalCode: 021352907
CountryCode: US
TelephoneNumber: 6177895004
FaxNumber: 6177796481
Other Information
ProviderEnumerationDate: 07/03/2013
LastUpdateDate: 07/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X256837MAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


Home