Provider Demographics
NPI:1447516265
Name:IMRAN, TASNIM F (MD)
Entity type:Individual
Prefix:DR
First Name:TASNIM
Middle Name:F
Last Name:IMRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:SOUTHCOAST PHYSICIANS GROUP, INC.
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02470
Practice Address - Country:US
Practice Address - Phone:508-973-5919
Practice Address - Fax:508-973-5916
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265452207R00000X
RIMD17160207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine