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General NPI Number Information
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NPI Number | 1619069085
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Entity Type | Organization
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Legal Business Name | BRUCE E ABBOTT
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 110 WOODFIELD DR
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City | GREENVILLE
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State | PA
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Zip | 16125-1250
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Country | US
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Telephone | 724-588-6160
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Fax | 724-588-0122
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | GREENVILLE
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State | PA
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Zip | 16125-0637
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Country | US
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Telephone | 724-588-6160
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Fax | 724-588-0122
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE E ABBOTT
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Credential |
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Telephone | 724-588-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC002545L
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License Number State | PA
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