Provider Demographics
NPI:1851437107
Name:ALAMEDDINE, ABDALLAH K (MD)
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:K
Last Name:ALAMEDDINE
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 1139
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:603-253-8987
Mailing Address - Fax:603-253-8988
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:603-253-8987
Practice Address - Fax:603-253-8988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55572174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA26124OtherHARVARD PILGRIM HEALTHCARE
MA020004182OtherRAILROAD MEDICARE
MA012418Medicaid
MA26124OtherHARVARD PILGRIM HEALTHCAR
MA714400OtherTUFTS HEALTHPLANS
MA0127418Medicaid