1457369423 NPI number — ABBA MEDICAL SUPPLIES CORPORATION

Table of content: DR. BRETT CHANDLER BAUDIN M.D. (NPI 1871550988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457369423 NPI number — ABBA MEDICAL SUPPLIES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBA MEDICAL SUPPLIES CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1457369423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3629 SILVERSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-478-5294
Provider Business Mailing Address Fax Number:
302-478-1548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3629 SILVERSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-478-5294
Provider Business Practice Location Address Fax Number:
302-478-1548
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADEJUWON
Authorized Official First Name:
AKINOLA
Authorized Official Middle Name:
HANSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-723-0055

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  2005207031 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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