Provider Demographics
NPI:1225099278
Name:ABRAMOVA, TATYANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:ABRAMOVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 WOODVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1956
Mailing Address - Country:US
Mailing Address - Phone:410-486-4721
Mailing Address - Fax:
Practice Address - Street 1:114 SLADE AVE
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4906
Practice Address - Country:US
Practice Address - Phone:443-872-7052
Practice Address - Fax:410-400-6085
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01408213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406074100Medicaid
MD406074100Medicaid
MDV00797Medicare UPIN