Provider Demographics
NPI:1972547339
Name:ABAD, AUGUSTO T (MD)
Entity type:Individual
Prefix:MR
First Name:AUGUSTO
Middle Name:T
Last Name:ABAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 TURKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TURKEY CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:41514-7901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-237-3914
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:SUITE 202C
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-1011
Practice Address - Fax:606-237-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30215174400000X
WV17537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000075313OtherBLUE CROSS BLUE SHIELD
KY64215031Medicaid
WV0076568000Medicaid
KY110196006OtherRAILROAD MEDICARE
KY110196006OtherUNITED HEALTH CARE
KY257029OtherHEALTHLINK
KY110196006OtherRAILROAD MEDICARE
KY257029OtherHEALTHLINK
KY64215031Medicaid