Healthcare Provider Details

I. General information

NPI: 1679015333
Provider Name (Legal Business Name): DALIA AKKAD ABAZA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BEL AIR SOUTH PKWY SUITE 1535
BEL AIR MD
21015-6091
US

IV. Provider business mailing address

5 BEL AIR SOUTH PKWY SUITE 1535
BEL AIR MD
21015-6091
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-2441
  • Fax:
Mailing address:
  • Phone: 410-569-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0006230
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: