Provider Demographics
NPI:1639969306
Name:ABOUELAZAEM, AHMED MOHAMED (MBBCH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED
Last Name:ABOUELAZAEM
Suffix:
Gender:
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA NUMBER 3, BLOCK 6/15, WEST SOMID, 6TH OF OCTOBER
Mailing Address - Street 2:
Mailing Address - City:GIZA
Mailing Address - State:EGYPT
Mailing Address - Zip Code:12566
Mailing Address - Country:EG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS STREET
Practice Address - Street 2:MEDICAL OFFICE BUILDING (MOB), 3RD FLOOR - ROOM 304
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program