Provider Demographics
NPI:1588722979
Name:EL-AMINE, ADNAN KAMEL (MD)
Entity type:Individual
Prefix:
First Name:ADNAN
Middle Name:KAMEL
Last Name:EL-AMINE
Suffix:
Gender:M
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-0001
Mailing Address - Country:US
Mailing Address - Phone:781-585-5518
Mailing Address - Fax:781-585-5510
Practice Address - Street 1:11 TREMONT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1231
Practice Address - Country:US
Practice Address - Phone:781-585-5518
Practice Address - Fax:781-585-5510
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3114457Medicaid
MA61901OtherHARVARD PILGRIM
MAJ14129OtherBCBS
MA731979OtherTUFTS
MA731979OtherTUFTS
MAF63894Medicare UPIN