Provider Demographics
NPI:1114905049
Name:ABERNATHY, DEBORAH ALISON (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ALISON
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84460
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-4460
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4950 ESSEN LN
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3738
Practice Address - Country:US
Practice Address - Phone:225-757-0343
Practice Address - Fax:225-757-8354
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014860207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357375Medicaid
B62796Medicare UPIN
LA267966YJXSMedicare PIN
51083Medicare PIN
LA1357375Medicaid