Provider Demographics
NPI:1093818932
Name:ABULFARAG, SUHAIR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUHAIR
Middle Name:A
Last Name:ABULFARAG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S FREDERICK AVE STE 413
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1284
Mailing Address - Country:US
Mailing Address - Phone:301-330-4414
Mailing Address - Fax:301-216-1637
Practice Address - Street 1:604 S FREDERICK AVE STE 413
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1284
Practice Address - Country:US
Practice Address - Phone:301-330-4414
Practice Address - Fax:301-216-1637
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40141802OtherBCBS
MD211791600Medicaid
MDB95037Medicare UPIN
MD457458Medicare ID - Type Unspecified