1871603381 NPI number — DR. MUKEMIL ABDELLA M.D.

Table of content: DR. MUKEMIL ABDELLA M.D. (NPI 1871603381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871603381 NPI number — DR. MUKEMIL ABDELLA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDELLA
Provider First Name:
MUKEMIL
Provider Middle Name:
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:
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:
1871603381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12200 ANNAPOLIS RD
Provider Second Line Business Mailing Address:
SUITE 229
Provider Business Mailing Address City Name:
GLENN DALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20769-9180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-245-4421
Provider Business Mailing Address Fax Number:
240-245-4424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12200 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 229
Provider Business Practice Location Address City Name:
GLENN DALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20769-9180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-245-4421
Provider Business Practice Location Address Fax Number:
240-245-4424
Provider Enumeration Date:
08/30/2006

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:  D0059981 , 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: J1200001 . This is a "DC BC BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 036237200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2119347 . This is a "FIRST HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 403013300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810621843 . This is a "TAX ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KFS6MU . This is a "MD BC BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1376604926 . This is a "GROUP NPI" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3237294 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2115095 . This is a "ALLIANCE/MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 617873 . This is a "NATIONAL CAPITAL PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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