Healthcare Provider Details

I. General information

NPI: 1346637071
Provider Name (Legal Business Name): MADINAH AALIYAH ABDULLAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 MINNESOTA AVE NE
WASHINGTON DC
20019-2661
US

IV. Provider business mailing address

3135 LYNDALE PL SE
WASHINGTON DC
20019-2164
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-8683
  • Fax:
Mailing address:
  • Phone: 240-305-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD046715
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: