Healthcare Provider Details

I. General information

NPI: 1225005721
Provider Name (Legal Business Name): AHMAD ABADULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4817 70TH AVE W
UNIVERSITY PLACE WA
98467-3225
US

IV. Provider business mailing address

4817 70TH AVE W
UNIVERSITY PLACE WA
98467-3225
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-8269
  • Fax:
Mailing address:
  • Phone: 253-565-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00035145
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD00035145
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: