MEDICARE: ABDUL H. JAMALUDEEN 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	207R00000X	Internal Medicine Physician	0101026029	VA

General Provider Information

NPI Number	:	1609830496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDUL H. JAMALUDEEN MD

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-594-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 E VIRGINIA AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23663-1619
Country	:	US
Telephone Number	:	757-427-8516
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	01/22/2008

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