Healthcare Provider Details

I. General information

NPI: 1780387944
Provider Name (Legal Business Name): MAWRA REHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBRAHAM RD STE 2
SPRINGFIELD MA
01109-3152
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-2511
  • Fax: 413-794-8428
Mailing address:
  • Phone: 413-794-5700
  • Fax: 413-794-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1027657
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: