Provider Demographics
NPI:1437213428
Name:ABRAHAM MATHEW, M.D, PC
Entity Type:Organization
Organization Name:ABRAHAM MATHEW, M.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-861-8151
Mailing Address - Street 1:3125 BALTIMORE BLVD
Mailing Address - Street 2:PO BOX 436
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2307
Mailing Address - Country:US
Mailing Address - Phone:410-861-8151
Mailing Address - Fax:410-833-9045
Practice Address - Street 1:3125 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2307
Practice Address - Country:US
Practice Address - Phone:410-861-8151
Practice Address - Fax:410-833-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG87116Medicare UPIN