Provider Demographics
NPI:1770263840
Name:ABDALLA, MAHMOUD (MD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ABDALLA
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 1:13601 BRUCE B DOWNS BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4694
Mailing Address - Country:US
Mailing Address - Phone:813-588-3516
Mailing Address - Fax:813-497-2236
Practice Address - Street 1:13601 BRUCE B DOWNS BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4694
Practice Address - Country:US
Practice Address - Phone:813-588-3516
Practice Address - Fax:813-497-2236
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program