Basic Information
Provider Information
NPI: 1760864003
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABDULGHANI
FirstName: MOHAMMED
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 856 J CLYDE MORRIS BLVD STE A
Address2:  
City: NEWPORT NEWS
State: VA
PostalCode: 236011318
CountryCode: US
TelephoneNumber: 7573165800
FaxNumber: 7575345190
Practice Location
Address1: 618 HOSPITAL RD
Address2:  
City: TAPPAHANNOCK
State: VA
PostalCode: 22560
CountryCode: US
TelephoneNumber: 8044433311
FaxNumber: 8044436150
Other Information
ProviderEnumerationDate: 06/23/2015
LastUpdateDate: 06/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X0101264263VAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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