Basic Information
Provider Information
NPI: 1508427741
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABUGHOUSH
FirstName: REEMA
MiddleName: HUSNI
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7068
Address2:  
City: PORTSMOUTH
State: VA
PostalCode: 237070068
CountryCode: US
TelephoneNumber: 7576863508
FaxNumber: 7576860541
Practice Location
Address1: 2800 GODWIN BLVD
Address2:  
City: SUFFOLK
State: VA
PostalCode: 234348038
CountryCode: US
TelephoneNumber: 7579678622
FaxNumber: 7576860541
Other Information
ProviderEnumerationDate: 06/27/2019
LastUpdateDate: 07/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000X0101274316VAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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