Provider Demographics
NPI:1073556130
Name:ABRAHAMSEN, ROBERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:ABRAHAMSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 WESTERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2424
Mailing Address - Country:US
Mailing Address - Phone:207-772-1820
Mailing Address - Fax:207-541-9138
Practice Address - Street 1:210 WESTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2424
Practice Address - Country:US
Practice Address - Phone:207-772-1820
Practice Address - Fax:207-541-9138
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME11061207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME225970000Medicaid
E21239Medicare UPIN
MEMM2647Medicare PIN
ME225970000Medicaid