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General NPI Number Information
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NPI Number | 1467763748
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Entity Type | Organization
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Legal Business Name | MARIE A ABOUGOU MD PC
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 428 WASHINGTON ST SUITE 4
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City | WATERTOWN
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State | NY
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Zip | 13601-3700
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Country | US
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Telephone | 315-788-0706
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Fax | 888-512-9113
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Provider Business Mailing Address
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Address Line | 428 WASHINGTON ST SUITE 4
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City | WATERTOWN
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State | NY
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Zip | 13601-3700
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Country | US
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Telephone | 315-788-0706
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Fax | 888-512-9113
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Authorized Official
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Title or Position | PROVIDER
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Name | MARIE ABOUGOU
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Credential |
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Telephone | 315-788-0706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 003258
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License Number State | NY
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