Provider Demographics
NPI:1407864887
Name:ABRAMOVICH, IRENE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:ABRAMOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 FARMINGTON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2672
Mailing Address - Country:US
Mailing Address - Phone:860-561-5515
Mailing Address - Fax:860-217-0631
Practice Address - Street 1:1216 FARMINGTON AVE
Practice Address - Street 2:304
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06040-2672
Practice Address - Country:US
Practice Address - Phone:860-561-5515
Practice Address - Fax:860-645-4132
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0331922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001331925Medicaid
CT001331925Medicaid