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NPI Code Detail

MEDICARE: DR. KURT S EBRAHIM D.O.

MEDICARE:  DR. KURT S EBRAHIM  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology Physician1271ME
2207RX0202XMedical Oncology Physician1271ME

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
8900001630OTHERMERR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11041691OTHERMEAETNA HMO
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31271OTHERMEMAINE LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5018305OTHERMEANTHEM BLUE SHIELD
64778555OTHERMECIGNA
75470239OTHERMEAETNA

General Provider Information

NPI Number : 1386615201
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KURT S EBRAHIM D.O.
Provider Business Mailing Address
First Line : PO BOX 911
Second Line :
City : BRATTLEBORO
State : VT
Zip : 05302-0911
Country : US
Telephone Number : 207-303-3200
Fax Number : 207-250-2140
Provider Business Practice Location Address
First Line : 2 INDEPENDENCE DR
Second Line :
City : KENNEBUNK
State : ME
Zip : 04043-6078
Country : US
Telephone Number : 207-303-3300
Fax Number : 207-250-2144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 03/30/2021

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Directions to “ DR. KURT S EBRAHIM D.O.” Practice Location

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