Healthcare Provider Details

I. General information

NPI: 1740135847
Provider Name (Legal Business Name): MR. ABDUL FATTAH ISMAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8443 GREENBELT RD APT 101
GREENBELT MD
20770-2522
US

IV. Provider business mailing address

8443 GREENBELT RD APT 101
GREENBELT MD
20770-2522
US

V. Phone/Fax

Practice location:
  • Phone: 646-396-0613
  • Fax:
Mailing address:
  • Phone: 646-396-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number302094564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: