Basic Information
| Provider Information | |||||||||
| NPI: | 1346422219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD ABISLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 905 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025410905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085488989 | ||||||||
| FaxNumber: | 5085485789 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 JONES RD | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025402974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084571500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | SOUZA | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING AGENCY | ||||||||
| AuthorizedOfficialTelephone: | 5085488989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 55882 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.