Provider Demographics
NPI:1629476023
Name:MOURAD, ABDUL RAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL RAHMAN
Middle Name:
Last Name:MOURAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDUL RAHMAN
Other - Middle Name:
Other - Last Name:MOURAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-8041
Mailing Address - Fax:401-444-4652
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-8041
Practice Address - Fax:401-444-4652
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03266207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology