Healthcare Provider Details

I. General information

NPI: 1114586385
Provider Name (Legal Business Name): ABIGAIL MARIE GUMPPER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGS WAY E STE D6
SEWELL NJ
08080-2238
US

IV. Provider business mailing address

2515 S 3RD ST
PHILADELPHIA PA
19148-4738
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-6082
  • Fax: 856-582-6082
Mailing address:
  • Phone: 215-882-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00369100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: