Healthcare Provider Details

I. General information

NPI: 1326116229
Provider Name (Legal Business Name): ABDULKAREEM I KRAIDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KAREEM I KRAIDY MD

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 BACKLICK RD
SPRINGFIELD VA
22150-3071
US

IV. Provider business mailing address

6801 BACKLICK RD STE A
SPRINGFIELD VA
22150-3071
US

V. Phone/Fax

Practice location:
  • Phone: 240-417-6424
  • Fax:
Mailing address:
  • Phone: 571-575-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236776
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0062159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: