Provider Demographics
NPI:1699450890
Name:GADALLAH, ABDELRAHMAN (MD)
Entity type:Individual
Prefix:MR
First Name:ABDELRAHMAN
Middle Name:
Last Name:GADALLAH
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:SSM HEALTH ST. MARY'S HOSPITAL, DEPT. OF INTERNAL
Mailing Address - Street 2:MEDICINE 6420 CLAYTON RD
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-768-8778
Mailing Address - Fax:
Practice Address - Street 1:SSM HEALTH ST. MARY'S HOSPITAL, DEPT. OF INTERNAL
Practice Address - Street 2:MEDICINE 6420 CLAYTON RD
Practice Address - City:ST.LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-768-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program