Basic Information
| Provider Information | |||||||||
| NPI: | 1639281090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABIB | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | HASHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | SOUTHBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015500040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089097799 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 128 MAIN ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | STURBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083479240 | ||||||||
| FaxNumber: | 5083475361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35078207 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 81726 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1639281090 | 01 | MA | PHCS | OTHER | AA211150 | 01 | MA | HPHC | OTHER | 2201243 | 01 | MA | CIGNA | OTHER | 1639281090 | 01 | MA | AETNA | OTHER | 1639281090 | 01 | MA | ANTHEM | OTHER | 97690404 | 01 | MA | NETWORK HEALTH | OTHER | 32000332 | 05 | MA | MEDICAID | 763121 | 01 | MA | TUFTS | OTHER | 110005581A | 05 | MA | MEDICAID | 1639281090 | 01 | MA | UNITED HEALTHCARE | OTHER | 0730301 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER |