Provider Demographics
NPI:1457510463
Name:HARES, ABDUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:K
Last Name:HARES
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 1:2200 WILSON BOULEVARD
Mailing Address - Street 2:SUITE 102-251
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201
Mailing Address - Country:US
Mailing Address - Phone:248-228-0069
Mailing Address - Fax:
Practice Address - Street 1:2200 WILSON BLVD
Practice Address - Street 2:SUITE 102-251
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3397
Practice Address - Country:US
Practice Address - Phone:248-228-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine