Healthcare Provider Details

I. General information

NPI: 1013053230
Provider Name (Legal Business Name): SADRUDDIN B HEMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HIGHLAND AVE SUITE 10
NEWBURYPORT MA
01950-3872
US

IV. Provider business mailing address

21 HIGHLAND AVE SUITE 10
NEWBURYPORT MA
01950-3872
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-3166
  • Fax: 978-462-5168
Mailing address:
  • Phone: 978-462-3166
  • Fax: 978-462-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number35461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: