Provider Demographics
NPI:1366543225
Name:ADDO, ABENA A (MD)
Entity type:Individual
Prefix:DR
First Name:ABENA
Middle Name:A
Last Name:ADDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:208 MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5208
Practice Address - Country:US
Practice Address - Phone:508-996-1800
Practice Address - Fax:508-992-7906
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11019207R00000X
MA223212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400199204OtherMEDICARE PTAN
MA110042076AMedicaid
RI29979OtherBLUE CROSS BLUE SHIELD
RI7626541OtherAETNA
RI010839832OtherUNITED HEALTH
RI410252OtherBLUE CHIP
RI961195OtherFIRST HEALTH
AA61978OtherHAVARD PILGRIM
RI007058112Medicare PIN
RI4211066OtherCIGNA