Provider Demographics
NPI:1033352109
Name:ADAB, HAMIDREZA (MD)
Entity Type:Individual
Prefix:
First Name:HAMIDREZA
Middle Name:
Last Name:ADAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:240-427-8973
Mailing Address - Fax:
Practice Address - Street 1:806 LAKE WINDERMERE CT
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-1532
Practice Address - Country:US
Practice Address - Phone:440-241-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012842390200000X
OH35-094998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3082364Medicaid
OH4296401Medicare PIN