Healthcare Provider Details

I. General information

NPI: 1730120049
Provider Name (Legal Business Name): CHARLES ABBOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 INTRACOASTAL DR APT 9B
FORT LAUDERDALE FL
33304-3632
US

IV. Provider business mailing address

936 INTRACOASTAL DR APT 9B
FORT LAUDERDALE FL
33304-3632
US

V. Phone/Fax

Practice location:
  • Phone: 413-822-8682
  • Fax:
Mailing address:
  • Phone: 413-822-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number212898
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number212898
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: