=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639969306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMED MOHAMED ABOUELAZAEM M.B.B.CH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2025
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 NEVINS STREET MEDICAL OFFICE BUILDING (MOB), 3RD FLOOR - ROOM 304
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-789-2386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | VILLA NUMBER 3, BLOCK 6/15, WEST SOMID, 6TH OF OCTOBER
-----------------------------------------------------
City | GIZA
-----------------------------------------------------
State | EGYPT
-----------------------------------------------------
Zip | 12566
-----------------------------------------------------
Country | EG
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------