MEDICARE: MOHAMMED ABDULATEEF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401417932	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	17392	MD

General Provider Information

NPI Number	:	1407312937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMED ABDULATEEF

Provider Business Mailing Address
First Line	:	10039 PATRIOT HWY
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9418
Country	:	US
Telephone Number	:	826-204-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	10039 PATRIOT HWY
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9418
Country	:	US
Telephone Number	:	826-204-2204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	10/31/2025

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