Basic Information
| Provider Information | |||||||||
| NPI: | 1659945079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABUELDOLEH | ||||||||
| FirstName: | SAMMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6105 GEORGE BAYLOR DR | ||||||||
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| City: | CENTREVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201214813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565358156 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037764001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2021 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.