MEDICARE: AYESHA ABDUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	0101276412	VA

General Provider Information

NPI Number	:	1124685474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA ABDUL MD

Provider Business Mailing Address
First Line	:	1600 N BEAUREGARD ST STE 300
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1732
Country	:	US
Telephone Number	:	703-717-4148
Fax Number	:	703-717-4149

Provider Business Practice Location Address
First Line	:	1600 N BEAUREGARD ST STE 300
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22311-1732
Country	:	US
Telephone Number	:	703-717-4148
Fax Number	:	703-717-4149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	09/09/2022

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