MEDICARE: EDMUND ABATE III PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9101934	FL
2	363AS0400X	Surgical Physician Assistant	PA9101934	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U2338Y	OTHER	FL	MEDICARE PTAN - QSS SCS
2	HF826A	OTHER	FL	MEDICARE PTAN - GRP QSS SCS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205820206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND ABATE III PA-C

Provider Business Mailing Address
First Line	:	410 CELEBRATION PL STE 200
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5432
Country	:	US
Telephone Number	:	407-303-4673
Fax Number	:	407-303-4674

Provider Business Practice Location Address
First Line	:	410 CELEBRATION PL STE 200
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5432
Country	:	US
Telephone Number	:	407-303-4673
Fax Number	:	407-303-4674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/03/2020

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Directions to “ EDMUND ABATE III PA-C” Practice Location

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