Provider Demographics
NPI:1740374404
Name:ABBOTT, MYLES B (MD)
Entity type:Individual
Prefix:DR
First Name:MYLES
Middle Name:B
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2999 REGENT ST.
Mailing Address - Street 2:SUITE 325
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2118
Mailing Address - Country:US
Mailing Address - Phone:925-253-9203
Mailing Address - Fax:510-841-5650
Practice Address - Street 1:2999 REGENT ST.
Practice Address - Street 2:SUITE 325
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2118
Practice Address - Country:US
Practice Address - Phone:925-253-9203
Practice Address - Fax:510-841-5650
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG25178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42559Medicare UPIN