Provider Demographics
NPI:1376015644
Name:AILERU, ABDULRAHAMAN
Entity Type:Individual
Prefix:
First Name:ABDULRAHAMAN
Middle Name:
Last Name:AILERU
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 1:115 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3914
Mailing Address - Country:US
Mailing Address - Phone:401-793-1599
Mailing Address - Fax:401-234-1060
Practice Address - Street 1:115 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3914
Practice Address - Country:US
Practice Address - Phone:401-793-1599
Practice Address - Fax:401-234-1060
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2193241172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver