Healthcare Provider Details

I. General information

NPI: 1639146426
Provider Name (Legal Business Name): AMIR RAHEMTULLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE SALEM HOSPITAL
SALEM MA
01970-2714
US

IV. Provider business mailing address

81 HIGHLAND AVE SALEM HOSPITAL
SALEM MA
01970-2714
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-4161
  • Fax:
Mailing address:
  • Phone: 978-354-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number152016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: