Provider Demographics
NPI:1891717757
Name:ABASHIDZE, ARCHIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHIL
Middle Name:
Last Name:ABASHIDZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10C QUEEN ELIZABETH CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2544
Mailing Address - Country:US
Mailing Address - Phone:443-312-2099
Mailing Address - Fax:410-768-1716
Practice Address - Street 1:7207 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2684
Practice Address - Country:US
Practice Address - Phone:410-768-0123
Practice Address - Fax:410-768-1716
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00079632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry