Provider Demographics
NPI:1376604926
Name:MUKEMIL ABDELLA MD LLC
Entity Type:Organization
Organization Name:MUKEMIL ABDELLA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MUKEMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-245-4421
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9180
Mailing Address - Country:US
Mailing Address - Phone:240-245-4421
Mailing Address - Fax:240-245-4424
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 229
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9180
Practice Address - Country:US
Practice Address - Phone:240-245-4421
Practice Address - Fax:240-245-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1871603381OtherINDIVIDUAL NPI NUMBER
MD2115095OtherALLIANCE
MDKFS6MUOtherMD BC BS
MD2119347OtherFIRST HEALTH
DC036237200Medicaid
MD3237294OtherAETNA
MD403013300Medicaid
MD617873OtherNATIONAL CAPITAL PPO
DCJ120001OtherDC BC BS
MD617873OtherNATIONAL CAPITAL PPO
MDH94017Medicare UPIN
MD=========OtherTAX ID