Provider Demographics
NPI:1487087375
Name:ALBALAWI, ABDULSALAM AHMED (MD)
Entity type:Individual
Prefix:
First Name:ABDULSALAM
Middle Name:AHMED
Last Name:ALBALAWI
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 1:88 THORNTON RD
Mailing Address - Street 2:88
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3611
Mailing Address - Country:US
Mailing Address - Phone:703-625-4161
Mailing Address - Fax:
Practice Address - Street 1:88 THORNTON RD
Practice Address - Street 2:88
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3611
Practice Address - Country:US
Practice Address - Phone:703-625-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA256413208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology