Basic Information
| Provider Information | |||||||||
| NPI: | 1811971898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIELDS | ||||||||
| FirstName: | ABBIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 W BELVEDERE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019030 | ||||||||
| FaxNumber: | 4106018576 | ||||||||
| Practice Location | |||||||||
| Address1: | 2411 W BELVEDERE AVE | ||||||||
| Address2: | MOWER 206 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019030 | ||||||||
| FaxNumber: | 4106018576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0041449 | MD | N | Other Service Providers | Specialist | 207VX0201X | 0101238598 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | 207VX0201X | D41449 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 010207797 | 05 | VA | MEDICAID |