Healthcare Provider Details

I. General information

NPI: 1427326321
Provider Name (Legal Business Name): BETH ABATE NURSE PRACTITIONER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 MAYFAIR RD
LAUREL MD
20707-5237
US

IV. Provider business mailing address

14625 BALTIMORE AVE STE 465
LAUREL MD
20707-4902
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-9995
  • Fax: 240-363-0063
Mailing address:
  • Phone: 240-447-9995
  • Fax: 301-776-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN965723
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETELEHEM ABATE
Title or Position: OWNER
Credential: APRN
Phone: 240-447-9995