Provider Demographics
NPI:1982685962
Name:MAZLOUM, NAJI WAGIH (MD)
Entity Type:Individual
Prefix:
First Name:NAJI
Middle Name:WAGIH
Last Name:MAZLOUM
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 1:333 SCHOOL ST
Mailing Address - Street 2:STE 305
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5337
Mailing Address - Country:US
Mailing Address - Phone:401-725-5560
Mailing Address - Fax:401-725-6610
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:STE 305
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5337
Practice Address - Country:US
Practice Address - Phone:401-725-5560
Practice Address - Fax:401-725-6610
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIRI7929208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002453Medicaid
MA0004378Medicare PIN
RI029002453Medicare PIN
RIF20851Medicare UPIN