Provider Demographics
NPI:1194134270
Name:IHEMDI, MD, MPH, SAMUEL I
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:I
Last Name:IHEMDI, MD, MPH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:I
Other - Last Name:IHEMDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:111 LINCOLN STREET
Mailing Address - Street 2:METROWEST MEDICAL CENTER
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-9167
Mailing Address - Country:US
Mailing Address - Phone:508-650-0166
Mailing Address - Fax:508-655-3378
Practice Address - Street 1:304 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1124
Practice Address - Country:US
Practice Address - Phone:508-650-0166
Practice Address - Fax:508-655-3378
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MAPH192151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No174H00000XOther Service ProvidersHealth Educator