Provider Demographics
NPI:1073049805
Name:ABDUR RAHMAN, MANAL MOHAMMAD (MD)
Entity Type:Individual
Prefix:MS
First Name:MANAL
Middle Name:MOHAMMAD
Last Name:ABDUR RAHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-296-2990
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:7 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7231
Practice Address - Country:US
Practice Address - Phone:601-296-2990
Practice Address - Fax:601-296-2860
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS27941207RH0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05135263Medicaid