Provider Demographics
NPI:1417924952
Name:DEVRIES, ABIGAIL G (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:G
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:299 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1821
Mailing Address - Country:US
Mailing Address - Phone:919-933-8494
Mailing Address - Fax:919-933-9201
Practice Address - Street 1:301 LLOYD ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1823
Practice Address - Country:US
Practice Address - Phone:919-942-8741
Practice Address - Fax:919-933-9201
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235360207Q00000X
NC2007-00170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02706141Medicaid
NY02706141Medicaid
NYRA7427Medicare ID - Type Unspecified