Provider Demographics
NPI:1821045550
Name:ELSHAAR, ABDULFATAH (MD)
Entity Type:Individual
Prefix:
First Name:ABDULFATAH
Middle Name:
Last Name:ELSHAAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-769-7070
Mailing Address - Fax:781-769-7085
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:SUITE 2-D
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-769-7070
Practice Address - Fax:781-769-7085
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA161357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA696660OtherHARVARD PILGRIM HEALTH
MAJ25934OtherBCBS OF MASS
MA0034046OtherNEIGHBORHOOD HEALTH
MA000000027373OtherBMC HEALTHNET
MA0189880Medicaid
MA161357OtherTUFTS HEALTH PLAN
MAP00242753OtherRAILROAD MEDICARE
MAMX8037Medicare PIN
H75738Medicare UPIN