Healthcare Provider Details

I. General information

NPI: 1790512143
Provider Name (Legal Business Name): ABDULLAHI MAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HOLTON ST
MEDFORD MA
02155-3513
US

IV. Provider business mailing address

18 HOLTON ST
MEDFORD MA
02155-3513
US

V. Phone/Fax

Practice location:
  • Phone: 617-869-8019
  • Fax:
Mailing address:
  • Phone: 617-869-8019
  • Fax: 617-758-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: