Provider Demographics
NPI:1790076560
Name:EDGAR ABOVICH, MD PA
Entity Type:Organization
Organization Name:EDGAR ABOVICH, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-624-3303
Mailing Address - Street 1:4425 MILITARY TRL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4819
Mailing Address - Country:US
Mailing Address - Phone:561-624-3303
Mailing Address - Fax:561-625-0588
Practice Address - Street 1:4425 MILITARY TRL
Practice Address - Street 2:SUITE 102
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4819
Practice Address - Country:US
Practice Address - Phone:561-624-3303
Practice Address - Fax:561-625-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57264Medicare UPIN