Provider Demographics
NPI:1952668303
Name:ABUCAR A. ABDULLE, MD. PC
Entity Type:Organization
Organization Name:ABUCAR A. ABDULLE, MD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABUCAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-730-5064
Mailing Address - Street 1:14409 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2128
Mailing Address - Country:US
Mailing Address - Phone:703-730-5064
Mailing Address - Fax:703-897-5284
Practice Address - Street 1:14409 HEREFORD RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2128
Practice Address - Country:US
Practice Address - Phone:703-730-5064
Practice Address - Fax:703-897-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF 71264Medicare UPIN