Provider Demographics
NPI:1992219216
Name:IKRAM, ASAD (MD)
Entity Type:Individual
Prefix:
First Name:ASAD
Middle Name:
Last Name:IKRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:DEPT. OF VASCULAR NEUROLOGY- ROOM # PALMER-127
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5491
Mailing Address - Country:US
Mailing Address - Phone:617-632-8981
Mailing Address - Fax:505-272-6692
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:DEPT. OF VASCULAR NEUROLOGY- ROOM # PALMER-127
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5491
Practice Address - Country:US
Practice Address - Phone:617-632-8981
Practice Address - Fax:505-272-6692
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMRS2017-1004390200000X
MA290773390200000X, 2084N0400X
NMMD2022-0007390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program