Provider Demographics
NPI:1235442195
Name:CHARLES E ABRAHAMSEN, MD, PA
Entity Type:Organization
Organization Name:CHARLES E ABRAHAMSEN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABRAHAMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-724-6169
Mailing Address - Street 1:1801 N BELCHER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1452
Mailing Address - Country:US
Mailing Address - Phone:727-724-6169
Mailing Address - Fax:727-791-0470
Practice Address - Street 1:1801 N BELCHER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1452
Practice Address - Country:US
Practice Address - Phone:727-724-6169
Practice Address - Fax:727-791-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62593AMedicare PIN