Provider Demographics
NPI:1861792483
Name:ABED ELNOOR, AHMAD (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:ABED ELNOOR
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 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4466
Mailing Address - Fax:207-564-1283
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:500
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4466
Practice Address - Fax:207-564-4468
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19368208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003309001OtherMEDICARE PTAN
P01258441OtherRR MEDICARE