Provider Demographics
NPI:1659428480
Name:AWAD, ESSAM R (MD)
Entity Type:Individual
Prefix:
First Name:ESSAM
Middle Name:R
Last Name:AWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1030 PRESIDENT AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:508-973-1780
Practice Address - Fax:508-973-0359
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD08344207RP1001X, 207RC0200X
MA72243207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEA04775Medicaid
MA110053347AMedicaid
RIEA04775Medicaid
RIU400186418Medicare PIN
MA110053347AMedicaid
MA0021180OtherNEIGHBORHOOD HEALTH PLANS
RI293848OtherBLUE CROSS BLUE SHIELD
RIEA04775Medicaid
RI204581OtherBLUECHIP OF RI
MA760389OtherTUFTS
MA110053347AMedicaid
MA3113558Medicaid
MA760389OtherTUFTS
RI007056480Medicare ID - Type Unspecified