MEDICARE: MICHAEL R ABIDIN MD

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	207YX0602X	Otolaryngic Allergy Physician	0101054696	VA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	0101054696	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00711443	OTHER	DC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568465912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R ABIDIN MD

Provider Business Mailing Address
First Line	:	224D CORNWALL ST NW STE 403
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-2704
Country	:	US
Telephone Number	:	703-737-6010
Fax Number	:	571-291-9786

Provider Business Practice Location Address
First Line	:	6355 WALKER LANE, SUITE 308
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3247
Country	:	US
Telephone Number	:	703-313-7700
Fax Number	:	703-313-0178

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/09/2023

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Directions to “ MICHAEL R ABIDIN MD” Practice Location

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