Individual
OMAIR K. MUTIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
718 SMYTH RD, MANCHESTER, NH 03104-7004
(603) 624-4366
Mailing address
WEST ROXBURY VAMC, 1400 VFW PKWY,, WESTROXBURY, MA 02132
(617) 323-7700
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
208851
MA
207R00000X
Internal Medicine Physician
Primary
208851
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207PE0004X
VA TAXONOMY
MA
Enumeration date
01/03/2006
Last updated
04/15/2020
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