Healthcare Provider Details

I. General information

NPI: 1881794493
Provider Name (Legal Business Name): HAMAD ALABDULRAZZAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 09/25/2007

III. Provider practice location address

87 MCGREGOR ST SUITE 2100
MANCHESTER NH
03102-3765
US

IV. Provider business mailing address

526 MAIN ST SUITE 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 603-626-7546
  • Fax: 603-626-7548
Mailing address:
  • Phone: 978-849-7507
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME96825
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME96825
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME96825
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME96825
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number13940
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number265468
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: