Provider Demographics
NPI:1700952314
Name:MAZRAANY, WASSIM (MD)
Entity type:Individual
Prefix:
First Name:WASSIM
Middle Name:
Last Name:MAZRAANY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:275 VARNUM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2109
Mailing Address - Country:US
Mailing Address - Phone:978-458-4300
Mailing Address - Fax:978-458-4311
Practice Address - Street 1:275 VARNUM AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2109
Practice Address - Country:US
Practice Address - Phone:978-458-4300
Practice Address - Fax:978-458-4311
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME016008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH68396Medicare UPIN
MEMM9579Medicare PIN