Provider Demographics
NPI:1053474320
Name:ORRA, ABDUL M (DO)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:M
Last Name:ORRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:N OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-0357
Mailing Address - Country:US
Mailing Address - Phone:216-226-2626
Mailing Address - Fax:216-226-6745
Practice Address - Street 1:13535 DETROIT AVE #4
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-226-2626
Practice Address - Fax:216-226-6745
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0582570Medicaid
OHOR0564513Medicare ID - Type Unspecified
OH0582570Medicaid