Provider Demographics
NPI:1881668564
Name:ABBADESSA, STEVEN MARK (DO)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MARK
Last Name:ABBADESSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N NEW BALLAS RD STE 154
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6827
Mailing Address - Country:US
Mailing Address - Phone:314-966-7570
Mailing Address - Fax:314-966-7788
Practice Address - Street 1:456 N NEW BALLAS RD STE 154
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6827
Practice Address - Country:US
Practice Address - Phone:314-966-7570
Practice Address - Fax:314-966-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5J14208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA65281Medicare UPIN