Basic Information
| Provider Information | |||||||||
| NPI: | 1861489585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABAY | ||||||||
| FirstName: | ABERA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 WAWECUS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 79 WAWECUS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608862655 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 11/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 039924 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 7734330 | 01 | AETNA PPO | OTHER | 2858099 | 01 | AETNA HMO | OTHER | 770220 | 01 | CT | CONNECTICARE | OTHER | P2671380 | 01 | CT | OXFORD HEALTH PLAN | OTHER | 010039924CT02 | 01 | CT | ANTHEM BCBS OF CT | OTHER |