Provider Demographics
NPI:1578551602
Name:QADDUMI, NIDAL MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDAL
Middle Name:MOHAMMAD
Last Name:QADDUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NIDAL
Other - Middle Name:MOHAMMAD
Other - Last Name:ABDEL-RAHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-715-4750
Mailing Address - Fax:202-715-4759
Practice Address - Street 1:900 23RD ST NW STE G-2092
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2342
Practice Address - Country:US
Practice Address - Phone:202-715-4750
Practice Address - Fax:202-715-4759
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266805207L00000X
TXL0736207L00000X
DCMD047552207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00260018OtherRAILROAD MEDICARE
TX143937405Medicaid
LA1115495OtherLOUISIANA MEDICAID
TX8S9660OtherBLUE CROSS PROVIDER ID
TXP00260018OtherRAILROAD MEDICARE
TXH37181Medicare UPIN