Provider Demographics
NPI:1053352492
Name:ABDO, HATEM S (MD)
Entity type:Individual
Prefix:
First Name:HATEM
Middle Name:S
Last Name:ABDO
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 1:301 SAINT PAUL PL
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 FONTANA LN
Practice Address - Street 2:STE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3047
Practice Address - Country:US
Practice Address - Phone:410-391-6904
Practice Address - Fax:410-686-6640
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019448207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLK36 / 350598-02OtherBC / BS OF MD
MD408351200Medicaid
MD461P 894GOtherMEDICARE
MDS186 / 0006OtherBLUECHOICE
S795 / 445VMedicare ID - Type Unspecified
B69923Medicare UPIN