Provider Demographics
NPI:1497770622
Name:MAKHDOMI, ABIDA T (MD)
Entity Type:Individual
Prefix:
First Name:ABIDA
Middle Name:T
Last Name:MAKHDOMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABIDA
Other - Middle Name:T
Other - Last Name:MAKHDOMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:855 S. WALL ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2859
Mailing Address - Country:US
Mailing Address - Phone:614-445-0965
Mailing Address - Fax:614-947-7159
Practice Address - Street 1:855 S. WALL ST.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2859
Practice Address - Country:US
Practice Address - Phone:614-445-0965
Practice Address - Fax:614-947-7159
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083632207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2628437Medicaid
I02925Medicare UPIN
MA4173361Medicare ID - Type Unspecified