Basic Information
Provider Information
NPI: 1780168351
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AL-ABDOUH
FirstName: AHMAD
MiddleName: ALI
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: 900 CATON AVE
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212295201
CountryCode: US
TelephoneNumber: 6672346000
FaxNumber:  
Practice Location
Address1: 800 ROSE ST
Address2:  
City: LEXINGTON
State: KY
PostalCode: 40536
CountryCode: US
TelephoneNumber: 8593236047
FaxNumber: 8592573873
Other Information
ProviderEnumerationDate: 09/19/2018
LastUpdateDate: 06/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X55204KYY Allopathic & Osteopathic PhysiciansHospitalist 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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