Provider Demographics
NPI:1316019912
Name:ABBASI, MUSTAFA AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:AHMED
Last Name:ABBASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4810 BEAUREGARD ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1709
Mailing Address - Country:US
Mailing Address - Phone:703-750-0108
Mailing Address - Fax:703-750-0230
Practice Address - Street 1:4810 BEAUREGARD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1709
Practice Address - Country:US
Practice Address - Phone:703-750-0108
Practice Address - Fax:703-750-0230
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
011882M92Medicare ID - Type Unspecified
F63619Medicare UPIN