Provider Demographics
NPI:1467763748
Name:MARIE A ABOUGOU MD PC
Entity Type:Organization
Organization Name:MARIE A ABOUGOU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUGOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-788-0706
Mailing Address - Street 1:428 WASHINGTON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3700
Mailing Address - Country:US
Mailing Address - Phone:315-788-0706
Mailing Address - Fax:888-512-9113
Practice Address - Street 1:428 WASHINGTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3700
Practice Address - Country:US
Practice Address - Phone:315-788-0706
Practice Address - Fax:888-512-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003258207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3072768Medicaid
NYJ400001464Medicare PIN