Provider Demographics
NPI:1417952284
Name:ABRAMSON, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:ABRAMSON
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 1:65 WALNUT ST STE 330
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2154
Mailing Address - Country:US
Mailing Address - Phone:617-630-0380
Mailing Address - Fax:617-630-2026
Practice Address - Street 1:65 WALNUT ST STE 330
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-2154
Practice Address - Country:US
Practice Address - Phone:617-630-0380
Practice Address - Fax:617-630-2026
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110045119AMedicaid
MA3028704Medicaid
MA6963OtherHARVARD PILGRIM HEALTH CA
MA728626OtherTUFTS HEALTH PLAN
MAJ07067OtherBLUE CROSS BLUE SHIELD
04-00887OtherUNITED HEALTHCARE
04-00194OtherEVERCARE
92420OtherAETNA US HEALTHCARE
P1495755OtherOXFORD HEALTH PLANS
MAB98143Medicare UPIN
MA110045119AMedicaid