Provider Demographics
NPI:1700982493
Name:FLETCHER, ABIGAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
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:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-1807
Mailing Address - Country:US
Mailing Address - Phone:562-933-0068
Mailing Address - Fax:562-933-0078
Practice Address - Street 1:450 E SPRING ST
Practice Address - Street 2:SUITE #1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1625
Practice Address - Country:US
Practice Address - Phone:562-933-0068
Practice Address - Fax:562-933-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67871207QA0000X, 207QA0505X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA67871AMedicare PIN
CAH29572Medicare UPIN