Healthcare Provider Details

I. General information

NPI: 1245220763
Provider Name (Legal Business Name): RIAD SALEM ALMUDALLAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 246
HAGERSTOWN MD
21742-6756
US

IV. Provider business mailing address

1939 ROLAND CLARKE PL STE 200
RESTON VA
20191-1445
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-4585
  • Fax:
Mailing address:
  • Phone: 703-435-3366
  • Fax: 703-782-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35053410
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101058637
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME106048
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD93995
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: