Provider Demographics
NPI:1023044252
Name:ABRAHAM, RICHARD I (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DOWD AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2401
Mailing Address - Country:US
Mailing Address - Phone:860-693-6951
Mailing Address - Fax:860-693-8459
Practice Address - Street 1:141 DOWD AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2401
Practice Address - Country:US
Practice Address - Phone:860-693-6951
Practice Address - Fax:860-693-8459
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017769207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1023044252Medicaid
CT1023044252Medicaid
CT110000799Medicare ID - Type Unspecified