Provider Demographics
NPI:1972787620
Name:GEORGE E ABBOUD MD PA
Entity type:Organization
Organization Name:GEORGE E ABBOUD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:207-283-4395
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-0950
Mailing Address - Country:US
Mailing Address - Phone:207-283-4935
Mailing Address - Fax:207-283-1016
Practice Address - Street 1:481 ALFRED ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9473
Practice Address - Country:US
Practice Address - Phone:207-283-4395
Practice Address - Fax:207-283-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED03664Medicare UPIN
MEMM6726Medicare PIN