Provider Demographics
NPI:1578663019
Name:ABU, RASAQ OLANREWAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:RASAQ
Middle Name:OLANREWAJU
Last Name:ABU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-0692
Mailing Address - Country:US
Mailing Address - Phone:301-854-6700
Mailing Address - Fax:301-854-5431
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE M-7
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-345-8225
Practice Address - Fax:301-345-8244
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43772207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD201101800Medicaid
F49954Medicare UPIN
MD201101800Medicaid