Provider Demographics
NPI:1578705877
Name:AMAR, ALBERT ABRAHAM (ABOC)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:ABRAHAM
Last Name:AMAR
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S FREDERICK AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1244
Mailing Address - Country:US
Mailing Address - Phone:240-643-1417
Mailing Address - Fax:
Practice Address - Street 1:600 S FREDERICK AVE STE 108
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1244
Practice Address - Country:US
Practice Address - Phone:240-643-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003599156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT2P5AAOtherBCBS