Provider Demographics
NPI:1144242066
Name:ABOVICH, EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:ABOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 MILITARY TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4819
Mailing Address - Country:US
Mailing Address - Phone:561-624-3303
Mailing Address - Fax:561-625-0588
Practice Address - Street 1:4425 MILITARY TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4819
Practice Address - Country:US
Practice Address - Phone:561-624-3303
Practice Address - Fax:561-625-0588
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047931207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57264Medicare UPIN
FL61514Medicare PIN