Healthcare Provider Details

I. General information

NPI: 1548149602
Provider Name (Legal Business Name): ABDI MOHAMED ABDIRAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

IV. Provider business mailing address

9040 CONNOR HOUSE RD APT 102
MANASSAS VA
20111-7214
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 571-599-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number5559
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: