Provider Demographics
NPI:1578851515
Name:QUDDUS, ABDULLAH (MD)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:QUDDUS
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 1:235 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3013
Mailing Address - Country:US
Mailing Address - Phone:272-212-4000
Mailing Address - Fax:866-230-6623
Practice Address - Street 1:235 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3013
Practice Address - Country:US
Practice Address - Phone:272-212-4000
Practice Address - Fax:866-230-6623
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02233207R00000X
IN01082327A207R00000X, 207RC0000X, 207RI0011X
PAMT207772207RC0000X
PAMD474639207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300029114Medicaid