Provider Demographics
NPI:1407827082
Name:ABOSH, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:ABOSH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8007 CORPORATE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4905
Mailing Address - Country:US
Mailing Address - Phone:410-256-8511
Mailing Address - Fax:410-256-1810
Practice Address - Street 1:8007 CORPORATE DR
Practice Address - Street 2:SUITE E
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4905
Practice Address - Country:US
Practice Address - Phone:410-256-8511
Practice Address - Fax:410-256-1810
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555984111N00000X
MDS02175111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD167636ZE6RMedicare UPIN