Provider Demographics
NPI:1841394954
Name:FADUL, ABDUL HAMID (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:HAMID
Last Name:FADUL
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 1098
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20750-1098
Mailing Address - Country:US
Mailing Address - Phone:301-870-2192
Mailing Address - Fax:301-609-9420
Practice Address - Street 1:6228 OXON HILL RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3033
Practice Address - Country:US
Practice Address - Phone:301-870-2192
Practice Address - Fax:301-609-9420
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13585207R00000X
MDD0015765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC431431D21Medicare PIN
MD745L675DMedicare PIN