Healthcare Provider Details

I. General information

NPI: 1225016587
Provider Name (Legal Business Name): TAHA ABDALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

6301 STEVENSON AVE #1404
ALEXANDRIA VA
22304-3527
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-6527
  • Fax:
Mailing address:
  • Phone: 571-723-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD035141
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD035141
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: