Individual
MARIANNE KHOURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
485 ARSENAL ST, WATERTOWN, MA 02472-5091
(617) 972-5570
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8239
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
161256
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025243
NEIGHBORHOOD HEALTH
MA
05
—
0158011
—
MA
01
—
161256
TUFTS
MA
01
—
HV0128
HARVARD PILGRIM
MA
01
—
J24349
BLUE CROSS
MA
Enumeration date
01/06/2006
Last updated
02/07/2012
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