Provider Demographics
NPI:1083662332
Name:ACKIL, ALBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:ACKIL
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:PO BOX 859207
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02185-9207
Mailing Address - Country:US
Mailing Address - Phone:800-927-0014
Mailing Address - Fax:
Practice Address - Street 1:15 ROCHE BROTHERS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:508-238-3455
Practice Address - Fax:508-238-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA361622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA036162OtherTUFTS HEALTH PLAN
MA2021668Medicaid
MAM08787OtherBCBS MA
MA130009225OtherRAILROAD MEDICARE
MA2021668Medicaid
MAM08787Medicare ID - Type Unspecified