Provider Demographics
NPI:1043544786
Name:LADER, ABBY C (DO)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:C
Last Name:LADER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14701 DETROIT AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4115
Mailing Address - Country:US
Mailing Address - Phone:216-221-5901
Mailing Address - Fax:216-221-5881
Practice Address - Street 1:14701 DETROIT AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4115
Practice Address - Country:US
Practice Address - Phone:216-221-5901
Practice Address - Fax:216-221-5881
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH58.003172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics