Provider Demographics
NPI:1467690834
Name:ABILLAR, MA IRENE D (MD)
Entity Type:Individual
Prefix:
First Name:MA IRENE
Middle Name:D
Last Name:ABILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:D
Other - Last Name:ABILLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:340 ARDSLEY PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3220
Mailing Address - Country:US
Mailing Address - Phone:615-335-5194
Mailing Address - Fax:615-425-3348
Practice Address - Street 1:601 W DUE WEST AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4423
Practice Address - Country:US
Practice Address - Phone:615-335-5194
Practice Address - Fax:615-425-3348
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD43856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics