Provider Demographics
NPI:1629350855
Name:ABDOU, REHAM (MD)
Entity Type:Individual
Prefix:
First Name:REHAM
Middle Name:
Last Name:ABDOU
Suffix:
Gender:F
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:PO BOX 31235
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1235
Mailing Address - Country:US
Mailing Address - Phone:520-324-4100
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5300 E ERICKSON DR STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2809
Practice Address - Country:US
Practice Address - Phone:520-324-7200
Practice Address - Fax:520-324-7201
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ568552080P0206X
NY08514390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ424175Medicaid
NY390200000XOtherINDIVIDUAL PROVIDER