Provider Demographics
NPI:1578557807
Name:YACOUB, TAMER (MD)
Entity Type:Individual
Prefix:
First Name:TAMER
Middle Name:
Last Name:YACOUB
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 1:235 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5246
Mailing Address - Country:US
Mailing Address - Phone:508-679-7742
Mailing Address - Fax:508-679-7768
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5246
Practice Address - Country:US
Practice Address - Phone:508-679-7742
Practice Address - Fax:508-679-7768
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78697207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31332Medicare UPIN
A21487Medicare PIN