Healthcare Provider Details

I. General information

NPI: 1093772022
Provider Name (Legal Business Name): HUSSEIN MOHAMED ABOULATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEADE PARKWAY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

2000 MEADE PARKWAY
SUFFOLK VA
23434-4259
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0251
  • Fax: 757-934-2564
Mailing address:
  • Phone: 757-539-0251
  • Fax: 757-934-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101042056
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: