Provider Demographics
NPI:1619056546
Name:ABESAMIS, AILEEN A (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:A
Last Name:ABESAMIS
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 1:680 CENTRE ST
Mailing Address - Street 2:SIGNATURE MEDICAL GROUP
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-2547
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:732-899-0008
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR9047208000000X
IL036121148208000000X
NJMA08466100208000000X
MA249872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9047OtherR NUMBER