Individual
MAMI A IWAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 STANIFORD ST, SUITE 600, BOSTON, MA 02114-2517
(617) 367-4800
(617) 723-7028
Mailing address
50 STANIFORD ST, SUITE 600, BOSTON, MA 02114-2517
(617) 367-4800
(617) 723-7028
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
75264
MA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
75264
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3093573
—
MA
01
—
730505
TUFTS HEALTH PLAN
MA
01
—
J12251
BCBS MA
MA
Enumeration date
11/09/2005
Last updated
01/21/2022
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