1902042641 NPI number — DR. ASHRAF YASIEN ADAM DDS

Table of content: DR. ASHRAF YASIEN ADAM DDS (NPI 1902042641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902042641 NPI number — DR. ASHRAF YASIEN ADAM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAM
Provider First Name:
ASHRAF
Provider Middle Name:
YASIEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1902042641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 NICHOLS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420-1919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-878-8300
Provider Business Mailing Address Fax Number:
978-665-5808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6316 CASTLE PL STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22044-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-237-7777
Provider Business Practice Location Address Fax Number:
703-533-2036
Provider Enumeration Date:
12/31/2008

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: 1223G0001X , with the licence number:  0401413742 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 10400 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1320815 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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