Healthcare Provider Details

I. General information

NPI: 1598251282
Provider Name (Legal Business Name): MOHAMMAD BASSAM ASAD ABDALLAH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N LA PLATA CT STE 202
LA PLATA MD
20646-5208
US

IV. Provider business mailing address

5 N LA PLATA CT STE 202 SUITE 202
LA PLATA MD
20646-5208
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-4276
  • Fax: 240-448-3117
Mailing address:
  • Phone: 301-609-4276
  • Fax: 240-448-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10063898
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD0102075
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2022023943
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number25MA11091200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: