Provider Demographics
NPI:1861623761
Name:AL MATROOD, AMEEN (MD)
Entity type:Individual
Prefix:
First Name:AMEEN
Middle Name:
Last Name:AL MATROOD
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 1:75 HOCKANUM BLVD
Mailing Address - Street 2:APT# 2713
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4056
Mailing Address - Country:US
Mailing Address - Phone:860-593-8577
Mailing Address - Fax:
Practice Address - Street 1:759 CHESTNUT ST
Practice Address - Street 2:S2570
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1001
Practice Address - Country:US
Practice Address - Phone:413-794-4373
Practice Address - Fax:413-794-8075
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0010120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine