Healthcare Provider Details

I. General information

NPI: 1528100211
Provider Name (Legal Business Name): ABU AHMED NASRULLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 106
LANSDOWNE VA
20176-8452
US

IV. Provider business mailing address

19415 DEERFIELD AVE STE 106
LANSDOWNE VA
20176-8470
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9633
  • Fax: 703-723-9772
Mailing address:
  • Phone: 703-723-9633
  • Fax: 703-723-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101232401
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: