Provider Demographics
NPI:1376612945
Name:ABBOUD, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:ABBOUD
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:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-0950
Mailing Address - Country:US
Mailing Address - Phone:207-283-4395
Mailing Address - Fax:207-283-1016
Practice Address - Street 1:481 ALFRED ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9473
Practice Address - Country:US
Practice Address - Phone:207-283-4395
Practice Address - Fax:207-283-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011277174400000X
MEMD11277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME129410000Medicaid
ME015265Medicare PIN
MED03664Medicare UPIN