Provider Demographics
NPI:1205810140
Name:ABADIE, WESLEY MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:MATTHEW
Last Name:ABADIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:305 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2501
Mailing Address - Country:US
Mailing Address - Phone:210-722-4593
Mailing Address - Fax:
Practice Address - Street 1:MALCOLM GROW MEDICAL CLINICS & SURGERY CENTER
Practice Address - Street 2:1060 W PERIMETER RD
Practice Address - City:JB ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-612-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01059866A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology