Provider Demographics
NPI:1710733951
Name:ISMAN, ABDOULKADER DJAMA
Entity type:Individual
Prefix:
First Name:ABDOULKADER
Middle Name:DJAMA
Last Name:ISMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BARTLETT ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6848
Mailing Address - Country:US
Mailing Address - Phone:207-955-0324
Mailing Address - Fax:
Practice Address - Street 1:40 BARTLETT ST APT 1F
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6848
Practice Address - Country:US
Practice Address - Phone:207-955-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant