Provider Demographics
NPI:1538209887
Name:DEBRA TANNER ABELL MD AND ASSOCIATES
Entity type:Organization
Organization Name:DEBRA TANNER ABELL MD AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:TANNER
Authorized Official - Last Name:ABELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-935-9133
Mailing Address - Street 1:11676 PERRY HWY
Mailing Address - Street 2:SUITE 2305
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-935-9133
Mailing Address - Fax:724-935-8711
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 2305
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-935-9133
Practice Address - Fax:724-935-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028796E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAB430634Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
PAAB568052Medicare ID - Type UnspecifiedGROUP NUMBER
PAB41697Medicare UPIN