Provider Demographics
NPI:1457392300
Name:ABDALLAH, MOHAMMED (DO)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3467 W HILLSBORO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9473
Mailing Address - Country:US
Mailing Address - Phone:561-483-3989
Mailing Address - Fax:754-227-5792
Practice Address - Street 1:3467 W HILLSBORO BLVD STE A
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9473
Practice Address - Country:US
Practice Address - Phone:561-483-3989
Practice Address - Fax:754-227-5792
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S81382086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70697Medicare UPIN
FL35478YMedicare PIN