Provider Demographics
NPI:1841266996
Name:ALAM, RABIUL (MD)
Entity type:Individual
Prefix:
First Name:RABIUL
Middle Name:
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMMED
Other - Middle Name:RABIUL
Other - Last Name:ALAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11660 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4943
Mailing Address - Country:US
Mailing Address - Phone:770-255-1069
Mailing Address - Fax:770-255-1075
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-255-1069
Practice Address - Fax:770-255-1075
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061549207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152235001Medicaid
SD6004470Medicaid
MN001671300Medicaid
SD0040594OtherBCBS
IA0559708Medicaid
IA0559708Medicaid
SDS40594Medicare PIN
AR152235001Medicaid