Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD040110L | PA |
NPI | 1003815374 |
---|---|
Provider Name | Dr. Elias Michael Abboud |
First Address | Jenkintown, PA 19046-3706 |
Second Address | Jenkintown, PA 19046-3706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 16/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
407963 | BCBS OF PA (01) | PA |
7080246 | (05) | PA |
BA1930797 | DFA LICENSE (01) | |
E64057 | (02) |