Provider Demographics
NPI:1255561569
Name:BEWLEY, ABIGAIL MAE CHIVERTON (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MAE CHIVERTON
Last Name:BEWLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MAE
Other - Last Name:CHIVERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 SYCAMORE AVE
Mailing Address - Street 2:#1527
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6710
Mailing Address - Country:US
Mailing Address - Phone:925-989-9938
Mailing Address - Fax:
Practice Address - Street 1:34TH ST. & CIVIC CENTER BLVD.,
Practice Address - Street 2:ROOM 9NW55
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4399
Practice Address - Country:US
Practice Address - Phone:215-590-2437
Practice Address - Fax:215-590-2768
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195016208000000X
PAMD445392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics