Provider Demographics
NPI:1831631159
Name:ABDULSALAM, ISHOLA
Entity type:Individual
Prefix:
First Name:ISHOLA
Middle Name:
Last Name:ABDULSALAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 GLEN DALE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9461
Mailing Address - Country:US
Mailing Address - Phone:240-280-6536
Mailing Address - Fax:
Practice Address - Street 1:11303 GLEN DALE FOREST RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9461
Practice Address - Country:US
Practice Address - Phone:240-280-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide