Basic Information
| Provider Information | |||||||||
| NPI: | 1720286289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOWLA | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | SAIFUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WARREN ST | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175625612 | ||||||||
| FaxNumber: | 6175625415 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 MAIN ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TOWNSEND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014691300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785979091 | ||||||||
| FaxNumber: | 9785979094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 08/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 243006 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 243006 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.