Provider Demographics
NPI:1730875568
Name:NADEEM, BILAWAL (MD)
Entity type:Individual
Prefix:
First Name:BILAWAL
Middle Name:
Last Name:NADEEM
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 1:11 NEVINS ST STE 308
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-789-3000
Mailing Address - Fax:815-205-4536
Practice Address - Street 1:ST. ELIZABETH'S MEDICAL CENTER
Practice Address - Street 2:736 CAMBRIDGE STREET
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2024-05-04
Deactivation Date:2023-11-17
Deactivation Code:
Reactivation Date:2023-12-05
Provider Licenses
StateLicense IDTaxonomies
MA3014713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine