Basic Information
| Provider Information | |||||||||
| NPI: | 1922367861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGHSOUDLOU | ||||||||
| FirstName: | ARMIN | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72 E CONCORD ST | ||||||||
| Address2: | EVANS 124 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386513 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Practice Location | |||||||||
| Address1: | 72 E CONCORD ST | ||||||||
| Address2: | EVANS 124 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176386513 | ||||||||
| FaxNumber: | 6176386501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2012 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 293464 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0008X | 293464 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine |
No ID Information.