Provider Demographics
NPI:1639115819
Name:ABUD, ALFREDO RAMON (MD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:RAMON
Last Name:ABUD
Suffix:
Gender:M
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:PO BOX 8500-8582
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-8582
Mailing Address - Country:US
Mailing Address - Phone:609-815-7810
Mailing Address - Fax:609-815-7814
Practice Address - Street 1:832 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3847
Practice Address - Country:US
Practice Address - Phone:609-394-6012
Practice Address - Fax:609-537-6002
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA036000002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0103654000OtherAMERI HEALTH
NJ95983785CMedicaid
F17068OtherHEALTHNET
133821OtherCHN
24723OtherAMERI GROUP
133821OtherCHN
0103654000OtherAMERI HEALTH