Provider Demographics
NPI:1710119045
Name:ABUBACKER KANIYAMPARAMBIL, FEROZ (MD)
Entity type:Individual
Prefix:
First Name:FEROZ
Middle Name:
Last Name:ABUBACKER KANIYAMPARAMBIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FEROZ
Other - Middle Name:
Other - Last Name:ABUBACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:4923 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2081
Practice Address - Country:US
Practice Address - Phone:302-225-0451
Practice Address - Fax:302-225-0472
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077262207RN0300X
DEC1-0010839207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD354244ZAN8Medicare PIN
DE352444ZBZRMedicare PIN