Healthcare Provider Details

I. General information

NPI: 1033900642
Provider Name (Legal Business Name): AHMED ABDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3884 BILLBERRY DR
FAIRFAX VA
22033-2479
US

IV. Provider business mailing address

3884 BILLBERRY DR
FAIRFAX VA
22033-2479
US

V. Phone/Fax

Practice location:
  • Phone: 804-882-9698
  • Fax:
Mailing address:
  • Phone: 804-882-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT234366
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0108092
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: