MEDICARE: DR. WAGIDA A ABDALLA M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	0101032266	VA

General Provider Information

NPI Number	:	1578582748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAGIDA A ABDALLA M.D.

Provider Business Mailing Address
First Line	:	6508 HEATHER BROOK CT
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101-1607
Country	:	US
Telephone Number	:	703-356-9896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 UNIVERSITY DR
Second Line	:	MSN 2D3, GEORGE MASON UNIVERSITY
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4422
Country	:	US
Telephone Number	:	703-993-2826
Fax Number	:	703-993-4365

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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