Provider Demographics
NPI:1164718540
Name:MARKHAM, ABBY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:A
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL STREET
Mailing Address - Street 2:MAINE MEDICAL CENTER DEPT OF PEDIATRICS
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-2541
Mailing Address - Fax:207-662-3172
Practice Address - Street 1:22 BRAMHALL STREET
Practice Address - Street 2:MAINE MEDICAL CENTER DEPT OF PEDIATRICS
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-662-2541
Practice Address - Fax:207-662-3172
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEMD20135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program