Provider Demographics
NPI:1891922514
Name:MCEWAN, ABIGAIL CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CATHERINE
Last Name:MCEWAN
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 1:10860 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5117
Mailing Address - Country:US
Mailing Address - Phone:813-355-8412
Mailing Address - Fax:813-355-8415
Practice Address - Street 1:10860 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-355-8412
Practice Address - Fax:813-355-8415
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014013937207Y00000X
FLME165322207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200014415Medicaid
MO200014415Medicaid