Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 1396 | SC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 1396 | SC |
NPI | 1235450685 |
---|---|
Provider Name | Siraj F. Abdullah |
First Address | Columbia, SC 29203-6894 |
Second Address | Columbia, SC 29203-6809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 24/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013960 | (05) | SC |