Provider Demographics
NPI:1255401063
Name:HABERMAN, ABIGAIL LEE (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEE
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 NW CALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9598
Mailing Address - Country:US
Mailing Address - Phone:541-754-2757
Mailing Address - Fax:541-754-3584
Practice Address - Street 1:690 NW CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9598
Practice Address - Country:US
Practice Address - Phone:541-754-2757
Practice Address - Fax:541-754-3584
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16039207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR041181Medicaid
R0000BLBXMMedicare ID - Type Unspecified
OR041181Medicaid