Provider Demographics
NPI:1962601062
Name:ABBOTT, JEFFREY MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL PARK
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-6534
Mailing Address - Fax:304-243-8575
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:SUITE 206
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-6534
Practice Address - Fax:304-243-8575
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013014207X00000X
WV2940207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021697720002Medicaid
OH0117146Medicaid
WV3810012467Medicaid
PA1021697720001Medicaid
PA126839EMHMedicare PIN