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:
Health care specialties
| Specialty | Code | License # | 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 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194798389 | NPPES |
| Massachusetts | MEDICAID | 110079565/A |
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