Basic Information
| Provider Information | |||||||||
| NPI: | 1215322383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABBOT | ||||||||
| FirstName: | MARY CLAIRE | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 W 158TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100327104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125441881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 W 158TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125441881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2015 | ||||||||
| LastUpdateDate: | 07/06/2018 | ||||||||
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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 | 207Q00000X | 294779 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.