Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D0019448 | MD |
NPI | 1053352492 |
---|---|
Provider Name | Hatem S Abdo |
First Address | Baltimore, MD 21202-2102 |
Second Address | Baltimore, MD 21237-3047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 14/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408351200 | (05) | MD |
461P 894G | MEDICARE (01) | MD |
B69923 | (02) | |
LK36 / 350598-02 | BC / BS OF MD (01) | MD |
S186 / 0006 | BLUECHOICE (01) | MD |