Basic Information
| Provider Information | |||||||||
| NPI: | 1104359181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBASI | ||||||||
| FirstName: | ANNAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 KOGER CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232354778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048972100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 LAKE HARLEY DR | ||||||||
| Address2: | |||||||||
| City: | PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238751259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048972100 | ||||||||
| FaxNumber: | 8048979074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101272071 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.