Provider Demographics
NPI:1255300307
Name:ABOULEISH, HASSAN E (MD)
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:E
Last Name:ABOULEISH
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 1:22 HARTFORD ST
Mailing Address - Street 2:SIGRID E TOMPKINS HEALTH CENTER
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1844
Mailing Address - Country:US
Mailing Address - Phone:207-532-4068
Mailing Address - Fax:207-532-5974
Practice Address - Street 1:22 HARTFORD ST
Practice Address - Street 2:SIGRID E TOMPKINS HEALTH CENTER
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-4068
Practice Address - Fax:207-532-5974
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C87364Medicare UPIN
MEMM3055Medicare PIN