Provider Demographics
NPI:1215022405
Name:ABRAHM, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ROBERT
Last Name:ABRAHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SUPERIOR AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3639
Mailing Address - Country:US
Mailing Address - Phone:949-631-2670
Mailing Address - Fax:949-631-7137
Practice Address - Street 1:1525 SUPERIOR AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3639
Practice Address - Country:US
Practice Address - Phone:949-631-2670
Practice Address - Fax:949-631-7137
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51196207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51196OtherLICENSE NUMBER
CAA51929Medicare UPIN