Provider Demographics
NPI:1073707808
Name:ABDALLAH, AHMED E (NCTMB)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:E
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 BALI RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6032
Mailing Address - Country:US
Mailing Address - Phone:410-908-9093
Mailing Address - Fax:410-461-8121
Practice Address - Street 1:7270 CRADLEROCK WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5025
Practice Address - Country:US
Practice Address - Phone:410-908-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20031401744R1103X
MDR00702225700000X
DCMT1014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder