Provider Demographics
NPI:1891765103
Name:ADIB, ABDULLA J (MD)
Entity type:Individual
Prefix:
First Name:ABDULLA
Middle Name:J
Last Name:ADIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-496-2600
Mailing Address - Fax:937-496-2610
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:937-496-2610
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35061277207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0833209Medicaid
43000283OtherAETNA
D61277OtherHUMANA
000000004244OtherANTHEM
1020159OtherUNITEDHEALTHCARE
OH040013112Medicare PIN
OH0833209Medicaid
G07148Medicare UPIN