Provider Demographics
NPI:1114903093
Name:ABBOTT, PAUL H
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NORTH DFFY ROAD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:878-271-6035
Mailing Address - Fax:878-271-6254
Practice Address - Street 1:353 N DUFFY RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1138
Practice Address - Country:US
Practice Address - Phone:878-271-6035
Practice Address - Fax:878-271-6254
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1035474363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004117700Medicaid
FL004117700Medicaid
FLES286ZMedicare PIN