Provider Demographics
NPI:1598251282
Name:ABDALLAH, MOHAMMAD BASSAM ASAD (MBBS)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:BASSAM ASAD
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N LA PLATA CT STE 202
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5208
Mailing Address - Country:US
Mailing Address - Phone:301-609-4276
Mailing Address - Fax:240-448-3117
Practice Address - Street 1:5 N LA PLATA CT STE 202
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5208
Practice Address - Country:US
Practice Address - Phone:301-609-4276
Practice Address - Fax:240-448-3117
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11091200207RI0008X
MDD0102075207RG0100X
MO2022023943207RG0100X
TXBP10063898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine