Provider Demographics
NPI:1245239623
Name:ABRAHAMSON, TIMOTHY GARTH (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GARTH
Last Name:ABRAHAMSON
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 1:2424 128TH ST
Mailing Address - Street 2:NW 128TH STREET
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-1816
Mailing Address - Country:US
Mailing Address - Phone:515-243-8676
Mailing Address - Fax:515-243-0487
Practice Address - Street 1:2424 128TH ST
Practice Address - Street 2:NW 128TH STREET
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-1816
Practice Address - Country:US
Practice Address - Phone:515-243-8676
Practice Address - Fax:515-243-0487
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33182207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA43541OtherBLUE CROSS
IA1233940Medicaid
IA1233940Medicaid
IA43541OtherBLUE CROSS