Basic Information
| Provider Information | |||||||||
| NPI: | 1013939198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOUDAN | ||||||||
| FirstName: | ABDUL | ||||||||
| MiddleName: | SHAHEED | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD | ||||||||
| Address2: | EXECUTIVE PLAZA1, SUITE 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210311002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102909191 | ||||||||
| FaxNumber: | 4102907330 | ||||||||
| Practice Location | |||||||||
| Address1: | 7120 MINSTREL WAY | ||||||||
| Address2: | STE 106 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102909191 | ||||||||
| FaxNumber: | 4102907330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | D0063349 | MD | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | D0063349 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.