Basic Information
Provider Information | |||||||||
NPI: | 1518946607 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALKURAYA | ||||||||
FirstName: | FOWZAN | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 77 AVENUE LOUIS PASTEUR | ||||||||
Address2: | NRB 458 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021155727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6175254710 | ||||||||
FaxNumber: | 6175254751 | ||||||||
Practice Location | |||||||||
Address1: | 300 LONGWOOD AVE | ||||||||
Address2: | FEGAN 10 | ||||||||
City: | BOSTON | ||||||||
State: | MA | ||||||||
PostalCode: | 021155724 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6173556000 | ||||||||
FaxNumber: | 6175254751 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/17/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SG0201X | 220648 | MA | X |   | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 208000000X | 220648 | MA | X |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.