Provider Demographics
NPI:1689694598
Name:AMR, MOSTAFA ABDALLA (MD)
Entity Type:Individual
Prefix:MR
First Name:MOSTAFA
Middle Name:ABDALLA
Last Name:AMR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910277
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0277
Mailing Address - Country:US
Mailing Address - Phone:859-373-1176
Mailing Address - Fax:859-275-0028
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 208
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2525
Practice Address - Country:US
Practice Address - Phone:859-373-1176
Practice Address - Fax:859-275-0028
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY37363207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056732Medicaid
KY64056732Medicaid
KYG47811Medicare UPIN