Provider Demographics
NPI:1558426759
Name:MAALOUF, ABDALLAH (DC)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:MAALOUF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1628
Mailing Address - Country:US
Mailing Address - Phone:617-661-6225
Mailing Address - Fax:
Practice Address - Street 1:2500 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1628
Practice Address - Country:US
Practice Address - Phone:617-661-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001761OtherTUFTS HEALTH PLAN
MA350017OtherHARVARD PILGRIM
MA4536144OtherAETNA
MAB20768803OtherCIGNA
MA4400383OtherUNITED HEALTH CARE
MAY36237OtherBCBS OF MA
MA4400383OtherUNITED HEALTH CARE
MA4536144OtherAETNA