Provider Demographics
NPI: | 1710119045 |
---|---|
Name: | ABUBACKER KANIYAMPARAMBIL, FEROZ (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | FEROZ |
Middle Name: | |
Last Name: | ABUBACKER KANIYAMPARAMBIL |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | FEROZ |
Other - Middle Name: | |
Other - Last Name: | ABUBACKER |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 4923 OGLETOWN STANTON RD |
Mailing Address - Street 2: | SUITE 200 |
Mailing Address - City: | NEWARK |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19713-2081 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-225-0451 |
Mailing Address - Fax: | 302-225-0472 |
Practice Address - Street 1: | 4923 OGLETOWN STANTON RD |
Practice Address - Street 2: | SUITE 200 |
Practice Address - City: | NEWARK |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19713-2081 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-225-0451 |
Practice Address - Fax: | 302-225-0472 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-08-20 |
Last Update Date: | 2021-06-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0077262 | 207RN0300X |
DE | C1-0010839 | 207RN0300X, 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 354244ZAN8 | Medicare PIN | |
DE | 352444ZBZR | Medicare PIN |