Provider Demographics
NPI:1790300374
Name:BOEHME, ABAGAEL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABAGAEL
Middle Name:MARIE
Last Name:BOEHME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4220
Mailing Address - Country:US
Mailing Address - Phone:717-263-0629
Mailing Address - Fax:
Practice Address - Street 1:214 PEACH ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:MCCONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233
Practice Address - Country:US
Practice Address - Phone:717-485-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical