Healthcare Provider Details

I. General information

NPI: 1710515465
Provider Name (Legal Business Name): SCOTT ABRAHAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 BROOKLANE DR
HAGERSTOWN MD
21742-1514
US

IV. Provider business mailing address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0099658
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64261
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: