Provider Demographics
NPI:1003875014
Name:ABASSI, IMRAN MUHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:MUHAMMAD
Last Name:ABASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:
Other - Last Name:IMRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:224A CORNWALL ST NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2701
Practice Address - Country:US
Practice Address - Phone:703-771-2894
Practice Address - Fax:703-779-5429
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 0848452084P0800X
VA01012413412084P0800X, 2084P0805X
WV237382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1003875014Medicaid
P00426205OtherMEDICARE RR
WVP00780939OtherMEDICARE RR
VA014847V29Medicare PIN
VA1003875014Medicaid