Healthcare Provider Details

I. General information

NPI: 1265978639
Provider Name (Legal Business Name): MOUSTAFA M ABOU AREDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

2002 MEDICAL PKWY STE 235
ANNAPOLIS MD
21401-3260
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-2770
  • Fax:
Mailing address:
  • Phone: 410-266-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0091996
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0091996
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: