Healthcare Provider Details

I. General information

NPI: 1104359181
Provider Name (Legal Business Name): ANNAM ABBASI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 LAKE HARLEY DR
PRINCE GEORGE VA
23875-1259
US

IV. Provider business mailing address

1212 KOGER CENTER BLVD
NORTH CHESTERFIELD VA
23235-4778
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-2100
  • Fax: 804-897-9074
Mailing address:
  • Phone: 804-897-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101272071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: