Provider Demographics
NPI:1902178726
Name:ABDUL WAHAB M D P C
Entity Type:Organization
Organization Name:ABDUL WAHAB M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-241-1010
Mailing Address - Street 1:6400 ARLINGTON BLVD
Mailing Address - Street 2:940
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2325
Mailing Address - Country:US
Mailing Address - Phone:703-241-1010
Mailing Address - Fax:703-241-7723
Practice Address - Street 1:6400 ARLINGTON BLVD
Practice Address - Street 2:940
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2325
Practice Address - Country:US
Practice Address - Phone:703-241-1010
Practice Address - Fax:703-241-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048306207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5604451Medicaid
DC731369Medicare PIN
VA5604451Medicaid