Provider Demographics
NPI:1942984158
Name:ABODORRA, MAHMOUD EMADELDIN (MD)
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:EMADELDIN
Last Name:ABODORRA
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 1:2424 ROBERTS LN APT #8, FLORENCE, ALABAMA
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-633-9390
Mailing Address - Fax:256-629-2765
Practice Address - Street 1:1701 VETERANS DR. NORTH ALABAMA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-629-1953
Practice Address - Fax:256-629-2765
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2024-02-06
Deactivation Date:2024-01-12
Deactivation Code:
Reactivation Date:2024-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program