Provider Demographics
NPI:1386615201
Name:EBRAHIM, KURT S (DO)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:S
Last Name:EBRAHIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0911
Mailing Address - Country:US
Mailing Address - Phone:207-303-3200
Mailing Address - Fax:207-250-2140
Practice Address - Street 1:2 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6078
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2144
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1271207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041691OtherAETNA HMO
ME30200551OtherNH MEDICAID
ME1271OtherMAINE LICENSE
ME224040099Medicaid
ME018305OtherANTHEM BLUE SHIELD
ME4778555OtherCIGNA
ME5470239OtherAETNA
ME900001630OtherRR MEDICARE
MEMM204301Medicare PIN
ME1271OtherMAINE LICENSE
ME5470239OtherAETNA
MEMM2043Medicare PIN