Provider Demographics
NPI:1952329146
Name:ABBOTT, JAMES DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 JANICE CT
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:MD
Mailing Address - Zip Code:21085-1112
Mailing Address - Country:US
Mailing Address - Phone:410-598-0948
Mailing Address - Fax:
Practice Address - Street 1:1114 JANICE CT
Practice Address - Street 2:
Practice Address - City:JOPPA
Practice Address - State:MD
Practice Address - Zip Code:21085-1112
Practice Address - Country:US
Practice Address - Phone:410-598-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023446207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00856501OtherRAILROAD MEDICARE
DC003593YT2Medicare PIN
DCP00856501OtherRAILROAD MEDICARE
MD162278ZBRPMedicare PIN