Provider Demographics
NPI:1699903724
Name:ABDELAAL, EBTEHAL A (MD)
Entity type:Individual
Prefix:
First Name:EBTEHAL
Middle Name:A
Last Name:ABDELAAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:6 MANHATTAN SQ STE 100
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5846
Practice Address - Country:US
Practice Address - Phone:757-826-2102
Practice Address - Fax:757-825-9482
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV7825AMedicare PIN
VA1699903724Medicaid
VAP01118648Medicare PIN