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NPI Code Detail

MEDICARE: HAZEM ALBASHASH MD

MEDICARE: HAZEM ALBASHASH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1053940742
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAZEM ALBASHASH MD
Provider Business Mailing Address
First Line : 41 ELLINGWOOD ST
Second Line :
City : BOSTON
State : MA
Zip : 02120-3366
Country : US
Telephone Number : 714-910-4625
Fax Number :
Provider Business Practice Location Address
First Line : 2015 PACIFIC AVE
Second Line :
City : ATLANTIC CITY
State : NJ
Zip : 08401-6726
Country : US
Telephone Number : 714-910-4625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2020
Last Update Date : 04/04/2020

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