Provider Demographics
NPI:1073659900
Name:ABDULLE, ABUCAR ADAN (INTERNAL MEDICINE MD)
Entity Type:Individual
Prefix:
First Name:ABUCAR
Middle Name:ADAN
Last Name:ABDULLE
Suffix:
Gender:M
Credentials:INTERNAL MEDICINE MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12761 DARBY BROOK CT
Mailing Address - Street 2:STE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2405
Mailing Address - Country:US
Mailing Address - Phone:703-730-5064
Mailing Address - Fax:571-408-4308
Practice Address - Street 1:12761 DARBY BROOK CT
Practice Address - Street 2:STE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2405
Practice Address - Country:US
Practice Address - Phone:703-730-5064
Practice Address - Fax:571-408-4308
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046722207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005844266Medicaid
VA005844266Medicaid
VA110006666Medicare ID - Type Unspecified
VAVV5451BMedicare PIN