Healthcare Provider Details

I. General information

NPI: 1699450890
Provider Name (Legal Business Name): ABDELRAHMAN GADALLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SSM HEALTH ST. MARY'S HOSPITAL, DEPT. OF INTERNAL MEDICINE 6420 CLAYTON RD
ST.LOUIS MO
63117
US

IV. Provider business mailing address

SSM HEALTH ST. MARY'S HOSPITAL, DEPT. OF INTERNAL MEDICINE 6420 CLAYTON RD
ST.LOUIS MO
63117
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8778
  • Fax:
Mailing address:
  • Phone: 314-768-8778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1026553
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: