Provider Demographics
NPI:1700049996
Name:ADRA, SOUHEIL (MD)
Entity type:Individual
Prefix:
First Name:SOUHEIL
Middle Name:
Last Name:ADRA
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 1:100 HIGHLAND ST STE 126
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3879
Mailing Address - Country:US
Mailing Address - Phone:617-313-1450
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND ST STE 126
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3879
Practice Address - Country:US
Practice Address - Phone:617-313-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA250697208600000X
CT52160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery