Provider Demographics
NPI:1558442525
Name:ABELL, DEBRA TANNER (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:TANNER
Last Name:ABELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ARLENE
Other - Last Name:ABELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11676 PERRY HWY
Mailing Address - Street 2:SUITE 2305
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-935-9133
Mailing Address - Fax:724-935-8711
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 2305
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-935-9133
Practice Address - Fax:724-935-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028796E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41697Medicare UPIN
PAAB430634Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAAB568052Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER