Provider Demographics
NPI:1174511794
Name:ABRAHAM, MATTHEW MACK (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MACK
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2851 JOHNSTON STREET
Mailing Address - Street 2:PMB 517
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3243
Mailing Address - Country:US
Mailing Address - Phone:337-561-8508
Mailing Address - Fax:833-561-2443
Practice Address - Street 1:100 ASMA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3858
Practice Address - Country:US
Practice Address - Phone:337-289-5605
Practice Address - Fax:337-289-5609
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2023-11-16
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Provider Licenses
StateLicense IDTaxonomies
LA024082207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1488909Medicaid
LAH21801Medicare UPIN
LA1488909Medicaid