1467409961 NPI number — DR. ABDULLAH AL FAROOQUE M.D

Table of content: DR. ABDULLAH AL FAROOQUE M.D (NPI 1467409961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467409961 NPI number — DR. ABDULLAH AL FAROOQUE M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAROOQUE
Provider First Name:
ABDULLAH
Provider Middle Name:
AL
Provider Name Prefix Text:
DR.
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:
FAROOQUE
Provider Other First Name:
ABDULLAH
Provider Other Middle Name:
AL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467409961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20167-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-393-8883
Provider Business Mailing Address Fax Number:
703-686-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8609 SUDLEY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-393-8883
Provider Business Practice Location Address Fax Number:
703-686-4240
Provider Enumeration Date:
05/28/2006

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:  0101227765 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005867568 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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