Provider Demographics
NPI:1639281090
Name:ABIB, MOHAMED HASHI (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:HASHI
Last Name:ABIB
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:
Practice Address - Street 1:128 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566
Practice Address - Country:US
Practice Address - Phone:508-347-9240
Practice Address - Fax:508-347-5361
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078207207Q00000X
MA81726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1639281090OtherPHCS
MAAA211150OtherHPHC
MA2201243OtherCIGNA
MA1639281090OtherAETNA
MA1639281090OtherANTHEM
MA97690404OtherNETWORK HEALTH
MA32000332Medicaid
MA763121OtherTUFTS
MA110005581AMedicaid
MA1639281090OtherUNITED HEALTHCARE
MA0730301OtherNEIGHBORHOOD HEALTH PLAN
MA2201243OtherCIGNA