Healthcare Provider Details

I. General information

NPI: 1972159598
Provider Name (Legal Business Name): ZAIN MOUSA AREF ALSHANABLEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CONGRESS ST STE B
PORTLAND ME
04102-2148
US

IV. Provider business mailing address

1600 CONGRESS ST STE B
PORTLAND ME
04102-2148
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-5222
  • Fax:
Mailing address:
  • Phone: 207-774-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT224937
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.248342
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD27593
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: