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NPI Code Detail

MEDICARE: DR. TED ROGER ABERNATHY M.D.

MEDICARE: DR. TED ROGER ABERNATHY M.D.
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
1208000000XPediatrics Physician0101020981VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538175690
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TED ROGER ABERNATHY M.D.
Provider Business Mailing Address
First Line : PO BOX 549
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23113-0549
Country : US
Telephone Number : 804-794-2821
Fax Number : 804-794-4072
Provider Business Practice Location Address
First Line : 13821 VILLAGE MILL DR
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-4365
Country : US
Telephone Number : 804-794-2821
Fax Number : 804-794-4072
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 01/05/2009

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