Provider Demographics
NPI:1922134899
Name:ABIGAIL MEDICAL FAMILY MEDICINE, L.L.C.
Entity Type:Organization
Organization Name:ABIGAIL MEDICAL FAMILY MEDICINE, L.L.C.
Other - Org Name:ABIGAIL FAMILY MEDICINE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:HORAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-738-3770
Mailing Address - Street 1:412 SUBURBAN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3564
Mailing Address - Country:US
Mailing Address - Phone:302-738-3770
Mailing Address - Fax:302-738-4749
Practice Address - Street 1:412 SUBURBAN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-3564
Practice Address - Country:US
Practice Address - Phone:302-738-3770
Practice Address - Fax:302-738-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20005526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty