Provider Demographics
NPI:1184650947
Name:ABDULLAH, ANWAR KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANWAR
Middle Name:KAMAL
Last Name:ABDULLAH
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 1:12909 SCRIMSHAW CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2580
Mailing Address - Country:US
Mailing Address - Phone:804-524-6540
Mailing Address - Fax:804-524-4866
Practice Address - Street 1:26317 WEST WASHINGTON STREET
Practice Address - Street 2:CENTRAL STATE HOSPITAL
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-524-6540
Practice Address - Fax:804-524-4866
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA608611-0Medicaid
VA608611-0Medicaid