Basic Information
Provider Information | |||||||||
NPI: | 1417919168 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EL-KADI | ||||||||
FirstName: | HISHAM | ||||||||
MiddleName: | S | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 690 CANTON STREET | ||||||||
Address2: | SUITE 325 | ||||||||
City: | WESTWOOD | ||||||||
State: | MA | ||||||||
PostalCode: | 020902329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7814077713 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 585 LEBANON STREET | ||||||||
Address2: | ANESTHETICS OF MASSACHUSETTS, PC | ||||||||
City: | MELROSE | ||||||||
State: | MA | ||||||||
PostalCode: | 02176 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7819793000 | ||||||||
FaxNumber: | 4014902141 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/06/2006 | ||||||||
LastUpdateDate: | 08/10/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 151527 | MA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   | 207L00000X | MD12287 | RI | N |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 3162028 | 05 | MA |   | MEDICAID |