Healthcare Provider Details

I. General information

NPI: 1508827593
Provider Name (Legal Business Name): AHMED M. ATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 SUMNER ST M201
STOUGHTON MA
02072
US

IV. Provider business mailing address

907 SUMNER ST M201 GUARDIAN ANESTHESIA INC
STOUGHTON MA
02072
US

V. Phone/Fax

Practice location:
  • Phone: 508-941-7000
  • Fax:
Mailing address:
  • Phone: 781-344-2325
  • Fax: 781-341-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number216741
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD11089
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: