Provider Demographics
NPI:1114586385
Name:GUMPPER, ABIGAIL MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:MARIE
Last Name:GUMPPER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4738
Mailing Address - Country:US
Mailing Address - Phone:215-882-0757
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS WAY E STE D6
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2238
Practice Address - Country:US
Practice Address - Phone:856-582-6082
Practice Address - Fax:856-582-6082
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MD00369100213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program