Provider Demographics
NPI:1477504413
Name:ABDALLAH, HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HASAN
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1701
Mailing Address - Country:US
Mailing Address - Phone:703-724-4003
Mailing Address - Fax:703-724-4408
Practice Address - Street 1:1830 TOWN CENTER DR
Practice Address - Street 2:SUITE #303
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3292
Practice Address - Country:US
Practice Address - Phone:703-481-5801
Practice Address - Fax:703-481-5804
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058336174400000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006716512Medicaid
VA006716512Medicaid