Provider Demographics
NPI:1871603381
Name:ABDELLA, MUKEMIL (MD)
Entity type:Individual
Prefix:DR
First Name:MUKEMIL
Middle Name:
Last Name:ABDELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9180
Mailing Address - Country:US
Mailing Address - Phone:240-245-4421
Mailing Address - Fax:240-245-4424
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 229
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9180
Practice Address - Country:US
Practice Address - Phone:240-245-4421
Practice Address - Fax:240-245-4424
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ1200001OtherDC BC BS
DC036237200Medicaid
MD2119347OtherFIRST HEALTH
MD403013300Medicaid
MD810621843OtherTAX ID
MDKFS6MUOtherMD BC BS
DC1376604926OtherGROUP NPI
MD3237294OtherAETNA
MD2115095OtherALLIANCE/MAMSI
MD617873OtherNATIONAL CAPITAL PPO
MDG01314Medicare ID - Type Unspecified
DC1376604926OtherGROUP NPI