Provider Demographics
NPI:1629475249
Name:GHULAM ABBAS MD LLC
Entity Type:Organization
Organization Name:GHULAM ABBAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-787-8030
Mailing Address - Street 1:493 CRUSADER DR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7763
Mailing Address - Country:US
Mailing Address - Phone:410-549-2396
Mailing Address - Fax:
Practice Address - Street 1:801 TOLL HOUSE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4564
Practice Address - Country:US
Practice Address - Phone:301-787-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62471207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1477658045Medicare PIN
MD126569Medicare UPIN