Healthcare Provider Details

I. General information

NPI: 1699400937
Provider Name (Legal Business Name): RAHAF ABDALLAH HASAN ALTA'ANY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 TURNPIKE ST
STOUGHTON MA
02072-6011
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 781-986-7800
  • Fax: 508-894-0412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1027953
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: