Healthcare Provider Details

I. General information

NPI: 1902868615
Provider Name (Legal Business Name): MARVIN ABDALAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/06/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANSFIELD BUILDING, LEVEL A 1500 FIFTH AVENUE
MCKEESPORT PA
15132
US

IV. Provider business mailing address

MANSFIELD BUILDING, LEVEL A 1500 FIFTH AVENUE
MCKEESPORT PA
15132
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2302
  • Fax:
Mailing address:
  • Phone: 412-664-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD440144
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: