Individual
HUSSAM ALDEEN JEFEE BAHLOUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-2148
(508) 856-5990
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
051858
CT
2084P0800X
Psychiatry Physician
Primary
261950
MA
2084P0802X
Addiction Psychiatry Physician
051858
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008050854
MEDICAID DR. BAHLOUL
CT
05
—
110103661A
—
MA
01
—
D400160566
MEDICARE DR. BAHLOUL
CT
Enumeration date
08/04/2009
Last updated
11/29/2020
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