Healthcare Provider Details

I. General information

NPI: 1184490609
Provider Name (Legal Business Name): ALZARIYAT MOHAMED ABDALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD STE 250
LAUREL MD
20707-3527
US

IV. Provider business mailing address

105 W CHERRY HILL RD
REISTERSTOWN MD
21136-3222
US

V. Phone/Fax

Practice location:
  • Phone: 800-994-5403
  • Fax:
Mailing address:
  • Phone: 443-707-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP13580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: