Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101054696 | VA |
NPI | 1568465912 |
---|---|
Provider Name | Michael R Abidin |
First Address | Leesburg, VA 20176-2704 |
Second Address | Alexandria, VA 22310-3247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1568465912 | (05) | VA |
P00711443 | RR MEDICARE (01) | DC |