Active NPI
Mohammed Azib M Alqahtani
- Epilepsy Physician
- Boston, MA
National Provider Identifier
1104718402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Epilepsy Physician
- License
- 3017839
- Practice address
- 300 Longwood Ave # Fegan11
Boston, MA 02115-5724 - Phone
- (617) 355-8735
- NPI assigned
- Jul 19, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | 3017839 | MA | |
| Epilepsy Physician | 2084E0001X | 3017839 | MA | Primary |
Addresses
Primary practice location
300 Longwood Ave # Fegan11
Boston, MA 02115-5724
Mailing address
300 Longwood Ave # Fegan11
Boston, MA 02115-5724
Phone (617) 355-8735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3017839 | MA | MD | Epilepsy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752883200000",
"number": "1104718402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVE # FEGAN11",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155724",
"telephone_number": "617-355-8735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVE # FEGAN11",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155724",
"telephone_number": "617-355-8735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALQAHTANI",
"first_name": "MOHAMMED",
"middle_name": "AZIB M",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-19",
"last_updated": "2025-07-19",
"certification_date": "2025-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0402X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
"state": "MA",
"license": "3017839",
"primary": false
},
{
"code": "2084E0001X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Epilepsy",
"state": "MA",
"license": "3017839",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.