Provider Demographics
NPI:1811017387
Name:ABBOUD, CAROL (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4773
Mailing Address - Country:US
Mailing Address - Phone:302-832-1126
Mailing Address - Fax:302-832-1129
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-832-1126
Practice Address - Fax:302-832-1129
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant