MEDICARE: ABDULRAOUF G. GHANDOUR M.D.

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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	251361	MA
2	207Q00000X	Family Medicine Physician	251361	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629276803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDULRAOUF G. GHANDOUR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 415348
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-5348
Country	:	US
Telephone Number	:	800-225-8885
Fax Number	:	508-334-1977

Provider Business Practice Location Address
First Line	:	188 WORCESTER PROVIDENCE TPKE
Second Line	:
City	:	SUTTON
State	:	MA
Zip	:	01590-1908
Country	:	US
Telephone Number	:	508-865-3650
Fax Number	:	508-865-3822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	12/01/2020

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