Provider Demographics
NPI:1811980113
Name:BANDAK, ABDALLA ZACKARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ABDALLA
Middle Name:ZACKARIA
Last Name:BANDAK
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 1:4920 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2052
Mailing Address - Country:US
Mailing Address - Phone:304-741-5510
Mailing Address - Fax:
Practice Address - Street 1:4920 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2052
Practice Address - Country:US
Practice Address - Phone:304-741-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV218392086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2532033OtherCIGNA
WV318939OtherCARELINK
WV3810002535Medicaid
WV5531469OtherAETNA
WV3810002535Medicaid
WV318939OtherCARELINK