=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104405307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABDILATIF A ABDULHAKIM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2021
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 TATE SPRINGS RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-1143
-----------------------------------------------------
Fax | 434-200-7070
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4004 W BROAD ST APT 305
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-3981
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-404-0730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 0116037154
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 0101287275
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------