Healthcare Provider Details

I. General information

NPI: 1376612945
Provider Name (Legal Business Name): GEORGE E ABBOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 ALFRED ROAD
BIDDEFORD ME
04005-9473
US

IV. Provider business mailing address

PO BOX 950
BIDDEFORD ME
04005-0950
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-4395
  • Fax: 207-283-1016
Mailing address:
  • Phone: 207-283-4395
  • Fax: 207-283-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number011277
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11277
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: