Healthcare Provider Details

I. General information

NPI: 1962343061
Provider Name (Legal Business Name): BADR ALI ABDULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1111 ARLINGTON BLVD APT 446
ARLINGTON VA
22209-3204
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-7646
  • Fax:
Mailing address:
  • Phone: 803-386-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: