Provider Demographics
NPI:1033134812
Name:ABOU-EZZI, PIERRE (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:ABOU-EZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 126Q
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-524-8181
Mailing Address - Fax:978-524-9868
Practice Address - Street 1:100 CUMMINGS CENTER
Practice Address - Street 2:SUITE 126Q
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-524-8181
Practice Address - Fax:978-524-9868
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3098818Medicaid
MA3098818Medicaid
F38724Medicare UPIN