Provider Demographics
NPI:1306071428
Name:ABERNETHY, ABRAHAM
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:ABERNETHY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CAMPUS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7164
Mailing Address - Country:US
Mailing Address - Phone:207-885-9905
Mailing Address - Fax:
Practice Address - Street 1:96 CAMPUS DR STE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7164
Practice Address - Country:US
Practice Address - Phone:207-885-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20788207RC0000X
MEMD24065207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease