1881694180 NPI number — DR. RAMI RUSTUM MD

Table of content: DR. RAMI RUSTUM MD (NPI 1881694180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881694180 NPI number — DR. RAMI RUSTUM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSTUM
Provider First Name:
RAMI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881694180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MERRIMACK ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01843-1779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-685-2455
Provider Business Mailing Address Fax Number:
978-685-2459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MERRIMACK ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01843-1779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-685-2455
Provider Business Practice Location Address Fax Number:
978-685-2459
Provider Enumeration Date:
07/28/2005

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: 207L00000X , with the licence number:  213741 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 213741 , 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)

  • Identifier: 202705274 . This is a "TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30204215 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1181899 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 97211605 . This is a "NETWORKHEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA52428 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000032259 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202705274 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6126042 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J25828 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203722881 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA64187 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0039262 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881694181 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 97211603 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 003715 . This is a "SR WHOLE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1881694180 . This is a "BMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 213741 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6126042 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA48214 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 202705274 . This is a "UHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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