Healthcare Provider Details

I. General information

NPI: 1346270006
Provider Name (Legal Business Name): IGRAR A ISMAIL-ZADE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

12 ABBOTT RD
DOVER MA
02030-1834
US

V. Phone/Fax

Practice location:
  • Phone: 508-363-6030
  • Fax: 774-893-4132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00040517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: