Healthcare Provider Details

I. General information

NPI: 1639115819
Provider Name (Legal Business Name): ALFREDO RAMON ABUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-3847
US

IV. Provider business mailing address

PO BOX 8500-8582
PHILADELPHIA PA
19178-8582
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-6012
  • Fax: 609-537-6002
Mailing address:
  • Phone: 609-815-7810
  • Fax: 609-815-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA03600000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: