Provider Demographics
NPI:1043259971
Name:ABRAHAM, NIRMALA ROSE (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:ROSE
Last Name:ABRAHAM
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 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:PHYSICIAN OFFICE BUILDING, SUITE 420
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-384-4511
Mailing Address - Fax:937-384-3837
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:PHYSICIAN OFFICE BUILDING, SUITE 420
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-384-4511
Practice Address - Fax:937-384-3837
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78127207L00000X
OH35.096133207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A781270303OtherCALOPTIMA
CAP00087619OtherRR MEDICARE
CA00A781270Medicaid
CA00A781270OtherBLUE SHIELD OF CA
OH3109488Medicaid
H88713Medicare UPIN
OH4308101Medicare PIN