Provider Demographics
NPI:1659323855
Name:ATEF, AMR MOHAMED (MD)
Entity Type:Individual
Prefix:
First Name:AMR
Middle Name:MOHAMED
Last Name:ATEF
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 1:130 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2624
Mailing Address - Country:US
Mailing Address - Phone:860-889-4600
Mailing Address - Fax:860-889-5200
Practice Address - Street 1:130 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2624
Practice Address - Country:US
Practice Address - Phone:860-889-4600
Practice Address - Fax:860-889-5200
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA39144Medicare PIN