Provider Demographics
NPI:1922754456
Name:ABDUL, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ABDUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CERASI DR APT 407
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15122-4205
Mailing Address - Country:US
Mailing Address - Phone:412-923-8372
Mailing Address - Fax:
Practice Address - Street 1:100 CERASI DR APT 407
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15122-4205
Practice Address - Country:US
Practice Address - Phone:412-923-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA638336013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant