1104880475 NPI number — DR. GEORGE A ABBOUD DPM

Table of content: DR. GEORGE A ABBOUD DPM (NPI 1104880475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104880475 NPI number — DR. GEORGE A ABBOUD DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOUD
Provider First Name:
GEORGE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104880475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 NEW CROSSING RD STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01867-3271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-944-4044
Provider Business Mailing Address Fax Number:
781-944-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 NEW CROSSING RD STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01867-3271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-944-4044
Provider Business Practice Location Address Fax Number:
781-944-4050
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2214 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: 2214 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8149109 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y71118 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 470022 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0364860 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0032914 . This is a "NEIGHBOORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA14775 . This is a "HARVARD PILGRIM HELATHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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