Provider Demographics
NPI:1275911307
Name:ABRAHAM, SUJA (CRNP)
Entity Type:Individual
Prefix:
First Name:SUJA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 GREENSPRING DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7603
Mailing Address - Country:US
Mailing Address - Phone:410-308-2300
Mailing Address - Fax:
Practice Address - Street 1:7101 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2114
Practice Address - Country:US
Practice Address - Phone:215-424-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014952363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology