Provider Demographics
NPI:1336388628
Name:MARK A. ABRAMOVICH, MD
Entity Type:Organization
Organization Name:MARK A. ABRAMOVICH, MD
Other - Org Name:MARK A. ABRAM, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABRAMOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-348-7648
Mailing Address - Street 1:300 W JOHN FITCH AVE
Mailing Address - Street 2:STE. 210
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1150
Mailing Address - Country:US
Mailing Address - Phone:502-348-7648
Mailing Address - Fax:502-348-7490
Practice Address - Street 1:300 W JOHN FITCH AVE
Practice Address - Street 2:STE. 210
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1150
Practice Address - Country:US
Practice Address - Phone:502-348-7648
Practice Address - Fax:502-348-7490
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK A. ABRAMOVICH, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5838P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty