Provider Demographics
NPI:1255349361
Name:ABDALLAH, JORGE M (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:M
Last Name:ABDALLAH
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 1:855 JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7223
Mailing Address - Country:US
Mailing Address - Phone:252-830-1867
Mailing Address - Fax:252-830-1003
Practice Address - Street 1:855 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7223
Practice Address - Country:US
Practice Address - Phone:252-830-1867
Practice Address - Fax:252-830-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34779207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891153MMedicaid
NC36-56186OtherUNITED HEALTHCARE
NC1153MOtherBCBS
NC2241911CMedicare PIN
NCG23846Medicare UPIN