Provider Demographics
NPI:1558689216
Name:ABUABARA, KATRINA ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ELAINE
Last Name:ABUABARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SPRUCE ST
Mailing Address - Street 2:2 MALONEY BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4211
Mailing Address - Country:US
Mailing Address - Phone:215-662-2737
Mailing Address - Fax:
Practice Address - Street 1:3600 SPRUCE ST
Practice Address - Street 2:2 MALONEY BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4211
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452542207N00000X
PAMT197330390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology