Individual
DR. BOUTROS MICHEL GHASSIBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34 HAVERHILL ST, LAWRENCE, MA 01841-2884
(978) 686-0090
(978) 681-5963
Mailing address
34 HAVERHILL ST, LAWRENCE, MA 01841-2884
(978) 686-0090
(978) 681-5963
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
72138
MA
207R00000X
Internal Medicine Physician
72138
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3166724
—
MA
Enumeration date
09/21/2006
Last updated
11/09/2017
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