Provider Demographics
NPI:1881694180
Name:RUSTUM, RAMI (MD)
Entity type:Individual
Prefix:DR
First Name:RAMI
Middle Name:
Last Name:RUSTUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MERRIMACK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1779
Mailing Address - Country:US
Mailing Address - Phone:978-685-2455
Mailing Address - Fax:978-685-2459
Practice Address - Street 1:280 MERRIMACK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1779
Practice Address - Country:US
Practice Address - Phone:978-685-2455
Practice Address - Fax:978-685-2459
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213741207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA202705274OtherTRICARE
NH30204215Medicaid
1181899OtherAETNA
MA97211605OtherNETWORKHEALTH
AA52428OtherHPHC
000000032259OtherHEALTHNET
202705274OtherUNICARE
6126042OtherCIGNA
J25828OtherBCBS
203722881OtherUHC
AA64187OtherHPHC
0039262OtherNHP
MA1881694181OtherBMC
MA97211603OtherNETWORK HEALTH
003715OtherSR WHOLE HEALTH
1881694180OtherBMC
213741OtherTUFTS
MA6126042OtherCIGNA
MAAA48214OtherHPHC
MA202705274OtherUHC
MA202705274OtherGRE AT WEST
MA7165429OtherAETNA
90110OtherFHP
MA2002299Medicaid
MAJ25828OtherBCBS
MA1881694181OtherBMC
1881694180OtherBMC
J25828OtherBCBS
AA64187OtherHPHC
202705274OtherUNICARE