Healthcare Provider Details

I. General information

NPI: 1376801548
Provider Name (Legal Business Name): MATTHEW RAYMOND ABATE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 1008
BATON ROUGE LA
70808-4368
US

IV. Provider business mailing address

10012 KENNERLY RD STE 305
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-0416
  • Fax: 314-525-4365
Mailing address:
  • Phone: 314-525-4325
  • Fax: 314-525-4365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2017013106
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number333086
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: