Provider Demographics
NPI:1699786848
Name:ALLAM, ABDEL F (MD)
Entity type:Individual
Prefix:DR
First Name:ABDEL
Middle Name:F
Last Name:ALLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:196 WOODLAND ST
Mailing Address - Street 2:PO BOX 2760
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-2760
Mailing Address - Country:US
Mailing Address - Phone:860-589-4742
Mailing Address - Fax:860-589-1658
Practice Address - Street 1:196 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5266
Practice Address - Country:US
Practice Address - Phone:860-589-4742
Practice Address - Fax:860-589-1658
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14043207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001140433Medicaid
CTB39328Medicare UPIN
CT001140433Medicaid