Provider Demographics
NPI:1366592487
Name:LABIB, MUTAZ M (MD)
Entity type:Individual
Prefix:
First Name:MUTAZ
Middle Name:M
Last Name:LABIB
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 1:395 BROWN ST
Mailing Address - Street 2:UNIT # 16
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-7475
Mailing Address - Country:US
Mailing Address - Phone:281-704-6284
Mailing Address - Fax:
Practice Address - Street 1:111 BREWSTER STREET
Practice Address - Street 2:MEMORIAL HOSPITAL OF RHODE ISLAND
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-729-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230630207R00000X
RIMD13433207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIML82503Medicaid
RI000361606OtherMEDICARE PTAN