Provider Demographics
NPI:1003117953
Name:GULLED, ABDIRAHMAN
Entity Type:Individual
Prefix:
First Name:ABDIRAHMAN
Middle Name:
Last Name:GULLED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WAVE AVE
Mailing Address - Street 2:3
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5452
Mailing Address - Country:US
Mailing Address - Phone:781-910-6883
Mailing Address - Fax:
Practice Address - Street 1:112 MARKET ST
Practice Address - Street 2:2RD FLR
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1125
Practice Address - Country:US
Practice Address - Phone:781-910-6883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker