Provider Demographics
NPI:1891716155
Name:DURRA, IMAD HISHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:IMAD
Middle Name:HISHAM
Last Name:DURRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:76 HIGH ST
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7649
Mailing Address - Country:US
Mailing Address - Phone:207-795-2729
Mailing Address - Fax:207-979-5272
Practice Address - Street 1:76 HIGH ST
Practice Address - Street 2:SUITE 4200
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7649
Practice Address - Country:US
Practice Address - Phone:207-795-2729
Practice Address - Fax:207-979-5272
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME015770207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH59621Medicare UPIN