Provider Demographics
NPI:1598819393
Name:ABDULNOUR, RAJA-ELIE EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:RAJA-ELIE
Middle Name:EDWARD
Last Name:ABDULNOUR
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 1:57 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6328
Mailing Address - Country:US
Mailing Address - Phone:443-749-4789
Mailing Address - Fax:
Practice Address - Street 1:77 AVENUE LOUIS PASTEUR
Practice Address - Street 2:HIM 807
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5727
Practice Address - Country:US
Practice Address - Phone:617-525-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA243283207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program