Mu'Taz Fahid Mezel Abualsha'R, MBBS
Individual provider Active NPI Internal Medicine Physician · Brighton, MA
NPI 1609500586 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1609500586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 293584 (MA)
- Practice address
- 736 Cambridge St
Brighton, MA 02135-2907 - Phone
- (617) 789-3000
- NPI assigned
- Jul 15, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230425001056 | MA | Order and Referring Only - Internal Medicine |
9133584246 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 293584 | MA | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 293584 | MA | Yes |
Addresses
Primary practice location
736 Cambridge St
Brighton, MA 02135-2907
Mailing address
1619 Commonwealth Ave Apt 1
Boston, MA 02135-4229
Phone (346) 492-1191
Other providers in Brighton, MA
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- Ikumi Abe
- Lara Aboud Syriani
- Ahmed Mohamed Abouelazaem
- Absolute Care, Inc.
- Angela Achkar
- Kathryn E Ackerman
- Martin A Acquadro
- Alexandra Kaye Adams
- Katherine Adams
All providers in Brighton, MA · Internal Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.