Provider Demographics
NPI:1033401856
Name:ABAABA, VERA UTAGAH (MD)
Entity Type:Individual
Prefix:DR
First Name:VERA
Middle Name:UTAGAH
Last Name:ABAABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INJUKEKWE
Other - Middle Name:VERA
Other - Last Name:UTAGAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:820 PRUDENTIAL DR STE 304
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8205
Practice Address - Country:US
Practice Address - Phone:904-202-3860
Practice Address - Fax:904-202-3846
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120882207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP10366899OtherRR MEDICARE
FL012801500Medicaid
FLP10366899OtherRR MEDICARE