1194134270 NPI number — DR. SAMUEL I IHEMDI, MD, MPH

Table of content: DR. SAMUEL I IHEMDI, MD, MPH (NPI 1194134270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194134270 NPI number — DR. SAMUEL I IHEMDI, MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IHEMDI, MD, MPH
Provider First Name:
SAMUEL
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IHEMDI
Provider Other First Name:
SAMUEL
Provider Other Middle Name:
I
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194134270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 LINCOLN STREET
Provider Second Line Business Mailing Address:
METROWEST MEDICAL CENTER
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01701-9167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-650-0166
Provider Business Mailing Address Fax Number:
508-655-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATICK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01760-1124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-650-0166
Provider Business Practice Location Address Fax Number:
508-655-3378
Provider Enumeration Date:
08/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: PH19215 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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