=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255361051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RIFAT B DWEIK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 HOPE AVE SUITE G07
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02453-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-894-1199
-----------------------------------------------------
Fax | 781-647-6178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 HOPE AVE SUITE G07
-----------------------------------------------------
City | WALTHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02453-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-894-1199
-----------------------------------------------------
Fax | 781-647-6178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 58014
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------