Healthcare Provider Details

I. General information

NPI: 1689694598
Provider Name (Legal Business Name): MOSTAFA ABDALLA AMR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 NICHOLASVILLE RD STE 208
LEXINGTON KY
40503-2525
US

IV. Provider business mailing address

PO BOX 910277
LEXINGTON KY
40591-0277
US

V. Phone/Fax

Practice location:
  • Phone: 859-373-1176
  • Fax: 859-275-0028
Mailing address:
  • Phone: 859-373-1176
  • Fax: 859-275-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37363
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37363
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: