Provider Demographics
NPI:1164468567
Name:ABRAHAM, DANA C (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:C
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 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 816
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-492-2600
Mailing Address - Fax:501-492-2601
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 816
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-492-2600
Practice Address - Fax:501-492-2601
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7650208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1474900000OtherQUALCHOICE OF ARKANSAS
AR130763001Medicaid
ARA5801088OtherAETNA INSURANCE
AR1474900000OtherQUALCHOICE OF ARKANSAS
G03623Medicare UPIN