=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285788455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABDULLAH & VINAYAKOM M D LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 10/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19517 DOCTORS DR
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20874-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-353-8700
-----------------------------------------------------
Fax | 301-474-7267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19517 DOCTORS DR
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20874-5247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-353-8700
-----------------------------------------------------
Fax | 301-474-7267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | SOFIA MALIK ABDULLAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 301-353-8700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D25882
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | D19449
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------