Abdalla Abouhaib, SO-ATP

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

02238959AA Issued in NC

Practice address

2D Reconnaissance BN
PCS 20138
Camp Lejeune, NC 28542-0138

Phone

(910) 440-7703

NPI assigned

Nov 22, 2023

Last updated

Nov 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1700611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1063287738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2D RECONNAISSANCE BATTALION",
            "address_2": "PCS BOX 20138",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420138",
            "telephone_number": "910-440-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2D RECONNAISSANCE BN",
            "address_2": "PCS 20138",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420138",
            "telephone_number": "910-440-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABOUHAIB",
        "first_name": "ABDALLA",
        "credential": "SO-ATP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-22",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "NC",
            "license": "02238959AA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 2D Recon BN
• Hannah Mackenzie Kidd Abdo, DMD
• Amanda Abrams, CLINICAL SOCIAL WORK
• Elizabeth Anne Abruzzo, DENTAL HYGIENIST
• Rachel Ellyn Ackerman, PHARM D
• Margaret Anne Ackley, PH.D.
• Christopher Larenz Acosta, DO

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.