Provider Demographics
NPI:1902974256
Name:MORTADA, RIAD K (MD)
Entity Type:Individual
Prefix:
First Name:RIAD
Middle Name:K
Last Name:MORTADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:31 PINE STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:508-623-3700
Mailing Address - Fax:508-623-3701
Practice Address - Street 1:31 PINE STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-623-3700
Practice Address - Fax:508-623-3701
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2017-01-05
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Provider Licenses
StateLicense IDTaxonomies
MA52762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA40619OtherFALLON HEALTH
MA052762OtherTUFTS HEALTH PLAN
MA3140067Medicaid
MA04-02110OtherUNITED HEALTHCARE
MA110182870OtherRAIL ROAD MEDICARE
MAJ15997OtherBCBS
MA18750OtherNEIGHBORHOOD HEALTH
MA68670OtherHARVARD PILGRIM HEALTH
MA18750OtherNEIGHBORHOOD HEALTH
MAJ15997OtherBCBS