Provider Demographics
NPI:1649345216
Name:ABDELSAYED, DALLAL W (MD)
Entity type:Individual
Prefix:MRS
First Name:DALLAL
Middle Name:W
Last Name:ABDELSAYED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 E WALLISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-3831
Mailing Address - Country:US
Mailing Address - Phone:281-426-8586
Mailing Address - Fax:281-426-7983
Practice Address - Street 1:607 E WALLISVILLE RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-3831
Practice Address - Country:US
Practice Address - Phone:281-426-8586
Practice Address - Fax:281-426-7983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121191402Medicaid
TX4388704OtherAETNA PROVIDER #
TX121191402Medicaid
TXB20751Medicare UPIN