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General NPI Number Information
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NPI Number | 1295149185
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Entity Type | Individual
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Provider Name | MAM ISMAAIL IBRAHEEM MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 75 FRANCIS ST
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City | BOSTON
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State | MA
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Zip | 02115-6110
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Country | US
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Telephone | 781-416-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 23 COBBLESTONE CIR
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-4547
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Country | US
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Telephone | 617-901-6692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 276559
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License Number State | MA
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