Provider Demographics
NPI:1417952029
Name:ABOCHAMH, DIA (MD)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:
Last Name:ABOCHAMH
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:PO BOX 951406
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75395-1406
Mailing Address - Country:US
Mailing Address - Phone:409-963-0000
Mailing Address - Fax:409-963-1899
Practice Address - Street 1:3921 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2118
Practice Address - Country:US
Practice Address - Phone:409-963-0000
Practice Address - Fax:409-963-1899
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2392207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK2392OtherLICENSE NO
TX169540501Medicaid
TXP00177686OtherRR MEDICARE
TXP00177686OtherRR MEDICARE
TX8C2402Medicare PIN