Provider Demographics
NPI:1457927568
Name:WOLKENBERG, ABIGAIL (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:WOLKENBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HONEYWOOD LN APT I
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8840
Mailing Address - Country:US
Mailing Address - Phone:410-340-0395
Mailing Address - Fax:
Practice Address - Street 1:515 FAIRMOUNT AVE STE 500
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8502
Practice Address - Country:US
Practice Address - Phone:410-494-7920
Practice Address - Fax:410-494-7920
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
MDC08333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant