Provider Demographics
NPI:1700834710
Name:FAM, NABIL ABDALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:ABDALLA
Last Name:FAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MERCY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2332
Mailing Address - Country:US
Mailing Address - Phone:843-374-9945
Mailing Address - Fax:843-374-5699
Practice Address - Street 1:324 MERCY ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2332
Practice Address - Country:US
Practice Address - Phone:843-374-9945
Practice Address - Fax:843-374-5699
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8455-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8455-20OtherSTATE LICENSE
SCGP2860Medicaid
SCB91951Medicare UPIN