Provider Demographics
NPI:1629728027
Name:BOBAN, ABIJHA BIJU (DO)
Entity Type:Individual
Prefix:
First Name:ABIJHA
Middle Name:BIJU
Last Name:BOBAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ABIJHA
Other - Middle Name:THEKKAKARA
Other - Last Name:BIJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:743 SPRING ST NE STE 710
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3715
Mailing Address - Country:US
Mailing Address - Phone:770-219-8730
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE STE 710
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program