Provider Demographics
NPI:1285627380
Name:AGRAMA, HANI M (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:M
Last Name:AGRAMA
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 1:225 ANDROS AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3311
Mailing Address - Country:US
Mailing Address - Phone:321-783-9557
Mailing Address - Fax:
Practice Address - Street 1:1257 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2488
Practice Address - Country:US
Practice Address - Phone:321-631-2277
Practice Address - Fax:321-631-2279
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME234042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05290OtherBLUE SHIELD
FLME23404OtherMEDICAL LICENSE NUMBER
4133237OtherAETNA PROVIDER NUMBER
FL050665600Medicaid
FL050665600Medicaid
AA5058652OtherDEA
FLD82330Medicare UPIN