Individual
ABIGAIL TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4000 MEDICAL CENTER DR SUITE 101DE, FAYETTEVILLE, NY 13066-6600
(315) 637-7878
(315) 637-7870
Mailing address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 744-1478
(315) 744-1218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
305958
NY
207Q00000X
Family Medicine Physician
312752
LA
207Q00000X
Family Medicine Physician
56540
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326488347
—
CT
Enumeration date
07/05/2013
Last updated
06/01/2023
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