| Doctor Name: | MAKUNDA ABDUL-MBACKE |
| NPI Number: | 1013995851 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 0101241089 |
| Business Practice Address: | 6890 Greensboro Rd Ridgeway, VA - 241483555 |
| Business Phone Number: | 2769561013 |
| Business Fax Number: | |
| Mailing Address: | 6890 Greensboro Rd, RIDGEWAY |
| State: | VA |
| Postal Code: | 241483555 |
| Phone Number: | 2769561013 |
| Fax Number: | |
| NPI Enumeration Date: | 01/03/2006 |
| NPI Last Update Date: | 06/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | 0101241089 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |