Provider Demographics
NPI:1801036942
Name:ABDAL HUSSAIN, LAYLA A (MD)
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:A
Last Name:ABDAL HUSSAIN
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 1:4379 RIDGEWOOD CENTER DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOOBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8323
Mailing Address - Country:US
Mailing Address - Phone:703-680-7950
Mailing Address - Fax:703-680-7953
Practice Address - Street 1:4379 RIDGEWOOD CENTER DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WOOBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8323
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:703-680-7953
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033379207R00000X
390200000X
VA0101249834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1801036942Medicaid