Provider Demographics
NPI:1154317816
Name:VAN DEN ABBEELE, ANNICK DIANE (MD)
Entity Type:Individual
Prefix:
First Name:ANNICK
Middle Name:DIANE
Last Name:VAN DEN ABBEELE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:RADIOLOGY, DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-2595
Mailing Address - Fax:617-582-8574
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:RADIOLOGY, DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-2595
Practice Address - Fax:617-582-8574
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-10-01
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Provider Licenses
StateLicense IDTaxonomies
MA78394207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA778060OtherTUFTS HEALTH CARE
MA3125084Medicaid
MAJ30495OtherBLUE CROSS/BLUE SHIELD
MAJ30495OtherBLUE CROSS/BLUE SHIELD
MAJ30495Medicare ID - Type Unspecified