Active NPI
Kurt S Ebrahim, D.O.
- Hematology & Oncology Physician
- Kennebunk, ME
National Provider Identifier
1386615201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 1271
- Practice address
- 2 Independence Dr
Kennebunk, ME 04043-6078 - Phone
- (207) 303-3300
- Fax
- (207) 250-2144
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 1271 | ME | Primary |
| Medical Oncology Physician | 207RX0202X | 1271 | ME |
Addresses
Primary practice location
2 Independence Dr
Kennebunk, ME 04043-6078
Mailing address
PO Box 911
Brattleboro, VT 05302-0911
Phone (207) 303-3200
Other practice location 1
51 US Route 1 Ste I
Scarborough, ME 04074-7145
Phone (207) 303-3300
Other practice location 2
105 Topsham Fair Mall Rd Unit 1
Topsham, ME 04086-1773
Phone (207) 729-1148
Other practice location 3
100 Campus Dr Unit 108
Scarborough, ME 04074-7172
Phone (207) 303-3300
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1041691 | Other | ME | AETNA HMO |
| 30200551 | Other | ME | NH MEDICAID |
| 1271 | Other | ME | MAINE LICENSE |
| 224040099 | Medicaid | ME | |
| 018305 | Other | ME | ANTHEM BLUE SHIELD |
| 4778555 | Other | ME | CIGNA |
| 5470239 | Other | ME | AETNA |
| 900001630 | Other | ME | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1271 | ME | MD | Medical Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1386615201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 911",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "053020911",
"telephone_number": "207-303-3200",
"fax_number": "207-250-2140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 INDEPENDENCE DR",
"city": "KENNEBUNK",
"state": "ME",
"postal_code": "040436078",
"telephone_number": "207-303-3300",
"fax_number": "207-250-2144"
}
],
"practiceLocations": [
{
"address_1": "51 US Route 1 Ste I",
"address_purpose": "LOCATION",
"city": "Scarborough",
"state": "ME",
"postal_code": "040747145",
"country_code": "US",
"telephone_number": "207-303-3300",
"fax_number": "207-303-3016",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "105 Topsham Fair Mall Rd Unit 1",
"address_purpose": "LOCATION",
"city": "Topsham",
"state": "ME",
"postal_code": "040861773",
"country_code": "US",
"telephone_number": "207-729-1148",
"fax_number": "207-729-2789",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 Campus Dr Unit 108",
"address_purpose": "LOCATION",
"city": "Scarborough",
"state": "ME",
"postal_code": "040747172",
"country_code": "US",
"telephone_number": "207-303-3300",
"fax_number": "207-396-7610",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EBRAHIM",
"first_name": "KURT",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "ME",
"license": "1271",
"primary": true
},
{
"code": "207RX0202X",
"taxonomy_group": "",
"desc": "Internal Medicine, Medical Oncology",
"state": "ME",
"license": "1271",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "1041691",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NH MEDICAID",
"identifier": "30200551",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINE LICENSE",
"identifier": "1271",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "224040099",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE SHIELD",
"identifier": "018305",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4778555",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5470239",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "900001630",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kennebunk, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.