Basic Information
Provider Information
NPI: 1639169063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADHAMI
FirstName: SEEMA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: PO BOX 415348
Address2:  
City: BOSTON
State: MA
PostalCode: 022415348
CountryCode: US
TelephoneNumber: 8002258885
FaxNumber: 5083341977
Practice Location
Address1: 55 LAKE AVE N
Address2: DEPARTMENT OF PEDIATRIC NEUROLOGY
City: WORCESTER
State: MA
PostalCode: 016550002
CountryCode: US
TelephoneNumber: 7744418084
FaxNumber: 5088564287
Other Information
ProviderEnumerationDate: 10/26/2005
LastUpdateDate: 11/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0402X214142MAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
2084N0400X214142MAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2080S0012X214142MAN Allopathic & Osteopathic PhysiciansPediatricsSleep Medicine

ID Information
IDTypeStateIssuerDescription
110007904A05MA MEDICAID


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