Domian, Ibrahim J

Domian, Ibrahim J is an individual health care provider with primary practice located at 55 Fruit St Yaw 5A, Boston MA 02114. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Domian, Ibrahim J can be contacted via phone (617) 726-7400.

Contact Information

Primary practice address
55 Fruit St Yaw 5A Boston MA 02114
Phone: (617) 726-7400
Fax: (617) 726-4149
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 216366 Massachusetts
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 216366 Massachusetts

Profile Details

NPI number 1194798389
LBN Legal business name Domian, Ibrahim J
Credentials MD PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Feb 12th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194798389 NPPES
Massachusetts MEDICAID 110079565/A

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