Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 213070 | MA |
N | 111NI0900X | Internist | 213070 | MA |
Y | 2086S0129X | Vascular Surgeon | 213070 | MA |
NPI | 1083616148 |
---|---|
Provider Name | Dr. Ibrahim Eid |
First Address | Fall River, MA 02724-2923 |
Second Address | Fall River, MA 02724-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 02/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97154 | (02) | MA |