Provider Demographics
NPI:1205106648
Name:ZUCKERBROD, ABRAHAM SOLOMON (OD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:SOLOMON
Last Name:ZUCKERBROD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860B REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1335
Mailing Address - Country:US
Mailing Address - Phone:410-864-2526
Mailing Address - Fax:410-230-1221
Practice Address - Street 1:1860B REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1335
Practice Address - Country:US
Practice Address - Phone:410-864-2526
Practice Address - Fax:410-230-1221
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2257152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2257OtherMD OPTOMETRY LICENSE
MD777335800Medicaid