Provider Demographics
NPI:1821277252
Name:ABELSON, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ABELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROLLING OAKS DR STE 160
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1031
Mailing Address - Country:US
Mailing Address - Phone:805-778-1513
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DR STE 160
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1031
Practice Address - Country:US
Practice Address - Phone:805-778-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1052362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821277252Medicaid
CA0A1052360Medicaid
CA00A1052360OtherBS OF CA
CA1821277252Medicaid
CACB203354Medicare PIN
CAGD789ZMedicare PIN
CACB203352Medicare PIN