Doctor Name: | AMJAD BAHNASSI |
NPI Number: | 1487754974 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 59555 |
Business Practice Address: | 202 Russell St Worcester, MA - 016092265 |
Business Phone Number: | 5087535554 |
Business Fax Number: | 5087527245 |
Mailing Address: | 202 Russell St, WORCESTER |
State: | MA |
Postal Code: | 016092265 |
Phone Number: | 5087535554 |
Fax Number: | 5087527245 |
NPI Enumeration Date: | 09/24/2006 |
NPI Last Update Date: | 04/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | 59555 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |