Basic Information
| Provider Information | |||||||||
| NPI: | 1568664589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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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 | 204F00000X | 2009-01485 | NC | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 2009-01485 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | MD12370 | RI | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 2009-01485 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 204F00000X | C100010447 | DE | Y | Allopathic & Osteopathic Physicians | Transplant Surgery | 204F00000X | 25MA07434600 | NJ | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 204F00000X | MD448939 | PA | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 2086S0120X | ME126220 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208600000X | ME126220 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | ME126220 | FL | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 2086S0120X | 25MA07434600 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 325309100 | 05 | MD | MEDICAID | 358075SAJ | 01 | PA | MEDICARE | OTHER | 102901546 | 05 | PA | MEDICAID | 0387258 | 05 | NJ | MEDICAID | 5912040 | 05 | NC | MEDICAID |