Provider Demographics
NPI:1265456420
Name:PLONK, ABIGAIL SAGAR (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SAGAR
Last Name:PLONK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N PEACE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4851
Mailing Address - Country:US
Mailing Address - Phone:336-768-1280
Mailing Address - Fax:336-760-8443
Practice Address - Street 1:2020 N PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4851
Practice Address - Country:US
Practice Address - Phone:336-768-1280
Practice Address - Fax:336-760-8443
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1071581OtherNCCPA NUMBER
NC0010-00502OtherSTATE LICENSE