Healthcare Provider Details

I. General information

NPI: 1760467526
Provider Name (Legal Business Name): SALAH ALRAKAWI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4807
US

IV. Provider business mailing address

170 MORTON ST
JAMAICA PLAIN MA
02130-3735
US

V. Phone/Fax

Practice location:
  • Phone: 857-307-3300
  • Fax:
Mailing address:
  • Phone: 617-522-8110
  • Fax: 617-971-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number154525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: