1376608620 NPI number — RASHEED ADEDAPO ABASSI M.D.

Table of content: LIDYA PACHECO-CARPENTER (NPI 1154729911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376608620 NPI number — RASHEED ADEDAPO ABASSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABASSI
Provider First Name:
RASHEED
Provider Middle Name:
ADEDAPO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376608620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9135 PISCATAWAY RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-868-2555
Provider Business Mailing Address Fax Number:
301-868-2933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9135 PISCATAWAY RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-868-1380
Provider Business Practice Location Address Fax Number:
304-868-4514
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D65329 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051031901 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 898864-01 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S062-0165 . This is a "BC/BS REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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