Provider Demographics
NPI:1871717538
Name:BENDER, ABBY DANIELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:DANIELLE
Last Name:BENDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:DANIELLE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:221 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2971
Mailing Address - Country:US
Mailing Address - Phone:336-570-3739
Mailing Address - Fax:336-570-1215
Practice Address - Street 1:221 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2971
Practice Address - Country:US
Practice Address - Phone:336-570-3739
Practice Address - Fax:336-570-1215
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-095739207Q00000X
NC2013-00563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3099221Medicaid
NC1871717538Medicaid
NC1871717538Medicaid
OH3099221Medicaid