=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972608933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE HORACIO ABREGO-GARCIA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 04/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 598 CYNWOOD DR
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-5755
-----------------------------------------------------
Fax | 410-820-0525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5564 MARLAN DR
-----------------------------------------------------
City | TRAPPE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21673-1908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-476-9798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0051132
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------