Healthcare Provider Details

I. General information

NPI: 1841685773
Provider Name (Legal Business Name): ABDALLAH ABDALLAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S STE 350
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

9320 US HIGHWAY 301 S STE 350
RIVERVIEW FL
33578-6300
US

V. Phone/Fax

Practice location:
  • Phone: 813-328-2070
  • Fax:
Mailing address:
  • Phone: 813-328-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberT3498
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME165827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: