Individual provider · Type 1 NPI

Simon Kidanemariam, MD

Student in an Organized Health Care Education/Training Program · Brockton, MA

NPI number 1811790652 Active

Practice location

680 Centre St
Brockton, MA 02302-3308

Call (508) 941-7210 Map

Mailing address

99 Irving Ave
Providence, RI 02906-4507

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1811790652

Simon Kidanemariam, MD's National Provider Identifier is 1811790652, issued on Mar 28, 2025. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Brockton, MA. The record was last updated on Mar 28, 2025.