Healthcare Provider Details

I. General information

NPI: 1588126510
Provider Name (Legal Business Name): ABDELRHMAN ABUMOAWAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 ALBANY ST
BOSTON MA
02118-2526
US

IV. Provider business mailing address

715 ALBANY ST # 437
BOSTON MA
02118-2526
US

V. Phone/Fax

Practice location:
  • Phone: 312-785-6140
  • Fax:
Mailing address:
  • Phone: 312-785-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number94-12566
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: