Healthcare Provider Details

I. General information

NPI: 1801405147
Provider Name (Legal Business Name): AHMED HAMDI ELDIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

630 SMITHFIELD RD APT 816
NORTH PROVIDENCE RI
02904-2931
US

V. Phone/Fax

Practice location:
  • Phone: 781-520-0715
  • Fax:
Mailing address:
  • Phone: 781-520-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number86178-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCLP05107
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: