Healthcare Provider Details

I. General information

NPI: 1033634647
Provider Name (Legal Business Name): MOHAMMAD ABDALLAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

IV. Provider business mailing address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2077
  • Fax:
Mailing address:
  • Phone: 929-217-7323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberCMD20274
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberCMD20274
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: