Provider Demographics
NPI:1447384011
Name:ABDOU, AMGAD W (MD)
Entity type:Individual
Prefix:
First Name:AMGAD
Middle Name:W
Last Name:ABDOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:P.O. BOX 79088
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279
Mailing Address - Country:US
Mailing Address - Phone:877-632-9292
Mailing Address - Fax:480-635-8111
Practice Address - Street 1:3031 JAVIER RD.
Practice Address - Street 2:STE. 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-560-8214
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-087394207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000513075OtherANTHEM BC/BS
OH2731842Medicaid
OH000000513075OtherANTHEM BC/BS