Provider Demographics
NPI:1720206212
Name:ABDULA, RAUSHAN (MD)
Entity Type:Individual
Prefix:
First Name:RAUSHAN
Middle Name:
Last Name:ABDULA
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:PO BOX 3339
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3339
Mailing Address - Country:US
Mailing Address - Phone:855-739-9953
Mailing Address - Fax:888-463-3944
Practice Address - Street 1:1201 SAM PERRY BLVD # B
Practice Address - Street 2:SUITE 205
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4490
Practice Address - Country:US
Practice Address - Phone:855-739-9953
Practice Address - Fax:888-463-3944
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250434207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06380OtherMEDICARE OF VA PTAN
DCG00773OtherDC PTAN