Provider Demographics
NPI:1326211582
Name:ELBROLOSY, BASEM MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:BASEM
Middle Name:MOHAMED
Last Name:ELBROLOSY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:1230 MAINE ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-7325
Practice Address - Country:US
Practice Address - Phone:207-998-4483
Practice Address - Fax:207-998-2189
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2020-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD24059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine