Provider Demographics
NPI:1962651927
Name:ABDUR-RAHMAN, ABDUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:
Last Name:ABDUR-RAHMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 ROLLING RD STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6230 ROLLING RD STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2326
Practice Address - Country:US
Practice Address - Phone:571-889-3235
Practice Address - Fax:571-889-3236
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
VA0110008678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant