Individual
KEVAN JOHN MAMDOUHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
41 MALL RD, BURLINGTON, MA 01805-0002
(781) 744-8000
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
290694
MA
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
290694
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110153881A
—
MA
Enumeration date
03/21/2019
Last updated
10/22/2024
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