Provider Demographics
NPI:1326116229
Name:KRAIDY, ABDULKAREEM I (MD)
Entity Type:Individual
Prefix:
First Name:ABDULKAREEM
Middle Name:I
Last Name:KRAIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAREEM
Other - Middle Name:I
Other - Last Name:KRAIDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6801 BACKLICK RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3071
Mailing Address - Country:US
Mailing Address - Phone:571-575-1027
Mailing Address - Fax:
Practice Address - Street 1:6801 BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3071
Practice Address - Country:US
Practice Address - Phone:240-417-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062159208D00000X
VA0101236776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI17287Medicare UPIN