Provider Demographics
NPI:1538346945
Name:KAREN RAE ABBOTT, M.D., LTD.
Entity type:Organization
Organization Name:KAREN RAE ABBOTT, M.D., LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-322-8883
Mailing Address - Street 1:1101 W MOANA LN
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4775
Mailing Address - Country:US
Mailing Address - Phone:775-322-8883
Mailing Address - Fax:775-827-8813
Practice Address - Street 1:1101 W MOANA LN
Practice Address - Street 2:SUITE 8
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4775
Practice Address - Country:US
Practice Address - Phone:775-322-8883
Practice Address - Fax:775-827-8813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN RAE ABBOTT, M.D., LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA11149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA45645Medicare UPIN