Provider Demographics
NPI:1518928589
Name:STANTON, ABIGAIL M (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:STANTON
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 1:1560 E CHEVY CHASE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4140
Mailing Address - Country:US
Mailing Address - Phone:818-240-0340
Mailing Address - Fax:818-545-7672
Practice Address - Street 1:1560 E CHEVY CHASE DR
Practice Address - Street 2:STE 130
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4140
Practice Address - Country:US
Practice Address - Phone:818-240-0340
Practice Address - Fax:818-545-7672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG627362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G627361Medicaid
E86064Medicare UPIN
G62736Medicare ID - Type Unspecified