Provider Demographics
NPI:1043285257
Name:SMITH, ABRAHAM J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ABRAHAM
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:9328 RIDINGS WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5832
Mailing Address - Country:US
Mailing Address - Phone:301-257-4046
Mailing Address - Fax:
Practice Address - Street 1:9328 RIDINGS WAY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5832
Practice Address - Country:US
Practice Address - Phone:301-257-4046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002792363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical