Individual
RANEEM S. ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7400
(508) 941-6200
Mailing address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7400
(508) 941-6200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
254434
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110095811A
—
MA
Enumeration date
07/14/2009
Last updated
06/16/2016
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