Basic Information
| Provider Information | |||||||||
| NPI: | 1689163651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | URUQ INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 1ST ST APT 333 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208511350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012751358 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3411 OLANDWOOD CT STE 105 | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017745260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2018 | ||||||||
| LastUpdateDate: | 05/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | ABDULLA | ||||||||
| AuthorizedOfficialFirstName: | LEITH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3012751348 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | D0080646 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | D0080646 | 01 | MD | MD DHMH LICENSE | OTHER |