Provider Demographics
NPI:1679664486
Name:ABDULLAH, SOSAN JAFFAR ALZIBAIR (MD)
Entity Type:Individual
Prefix:
First Name:SOSAN
Middle Name:JAFFAR ALZIBAIR
Last Name:ABDULLAH
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 1:352 E PARKER RD STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5122
Mailing Address - Country:US
Mailing Address - Phone:828-580-3250
Mailing Address - Fax:828-580-3259
Practice Address - Street 1:352 E PARKER RD STE B
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5122
Practice Address - Country:US
Practice Address - Phone:828-580-3250
Practice Address - Fax:828-580-3259
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01192207RN0300X
VA101245222207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679664486Medicaid
VA020566L49Medicare PIN