Basic Information
| Provider Information | |||||||||
| NPI: | 1164718540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GROSS | ||||||||
| OtherFirstName: | ABBY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 22 BRAMHALL STREET | ||||||||
| Address2: | MAINE MEDICAL CENTER DEPT OF PEDIATRICS | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622541 | ||||||||
| FaxNumber: | 2076623172 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 BRAMHALL STREET | ||||||||
| Address2: | MAINE MEDICAL CENTER DEPT OF PEDIATRICS | ||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076622541 | ||||||||
| FaxNumber: | 2076623172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD20135 | ME | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.