Basic Information
| Provider Information | |||||||||
| NPI: | 1407034911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AL MUBARAK | ||||||||
| FirstName: | GHADA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 EAST FIFTH STREET | ||||||||
| Address2: | |||||||||
| City: | COQUILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974231666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413963111 | ||||||||
| FaxNumber: | 5413961783 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 WASHINGTON ST | ||||||||
| Address2: | SURGERY DEPT, TUFTS-NEMC | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021111526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176365891 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD170379 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.