Provider Demographics
NPI:1013770676
Name:UDDIN, MD S
Entity Type:Individual
Prefix:
First Name:MD
Middle Name:S
Last Name:UDDIN
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 1:9516 COVINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3328
Mailing Address - Country:US
Mailing Address - Phone:571-243-2566
Mailing Address - Fax:
Practice Address - Street 1:207 E HOLLY AVE STE 215
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-3137
Practice Address - Country:US
Practice Address - Phone:571-243-2566
Practice Address - Fax:703-953-1227
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide