Provider Demographics
NPI:1922088582
Name:THAYYIL, ABDULLAH (MD)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:THAYYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMESH
Other - Middle Name:
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-9609
Mailing Address - Fax:319-356-8470
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-9609
Practice Address - Fax:319-356-8470
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36368207ZP0102X
NC2019-01490207ZP0102X
IAMD-36368207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922088582Medicaid
NCNN7976AOtherMEDICARE
IA0475400Medicaid
IA39987OtherWELLMARK BCBS
IA39988OtherWELLMARK BCBS
IA1475400Medicaid
NC20390OtherBCBS OF NC
IAI16510Medicare PIN