Provider Demographics
NPI:1518972306
Name:DABELA, ABRAHAM BAKE (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:BAKE
Last Name:DABELA
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 1:6810 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2923
Mailing Address - Country:US
Mailing Address - Phone:301-469-4856
Mailing Address - Fax:
Practice Address - Street 1:4404 QUEENSBURY RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:301-779-1949
Practice Address - Fax:301-699-1703
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD9880207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04794OtherAMERIGROUP
MD7596 0001OtherCAREFIRST BLUECROSS BLUES
MD315771700Medicaid
MD315771700Medicaid
MD104837Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION