Provider Demographics
NPI:1659542801
Name:ELBASH, ABDEL-RAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDEL-RAHMAN
Middle Name:
Last Name:ELBASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44125 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:571-291-2432
Mailing Address - Fax:703-542-4254
Practice Address - Street 1:44125 WOODRIDGE PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:571-291-2432
Practice Address - Fax:703-542-4254
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101245181207W00000X
SCTL31098207W00000X
NY226841207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1659542801OtherRAILROAD MEDICARE
SC1659542801Medicaid
VA1659542801Medicare UPIN
SC1659542801Medicaid