Provider Demographics
NPI:1922674134
Name:ABOU EL NASR EL BASSATNE, AYA (MD)
Entity type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:ABOU EL NASR EL BASSATNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E CONCORD ST # C318
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2642
Mailing Address - Country:US
Mailing Address - Phone:617-414-5634
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-638-7470
Practice Address - Fax:708-684-2032
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2025-01-22
Deactivation Date:2022-11-25
Deactivation Code:
Reactivation Date:2023-04-26
Provider Licenses
StateLicense IDTaxonomies
IL125077960207R00000X
390200000X
MA3015690207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program