Provider Demographics
NPI:1497750764
Name:ABRAHAM, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ABRAHAM
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 1:42 STATE RD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1810
Mailing Address - Country:US
Mailing Address - Phone:207-651-7432
Mailing Address - Fax:888-519-0831
Practice Address - Street 1:42 STATE RD UNIT 103
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1810
Practice Address - Country:US
Practice Address - Phone:207-651-7432
Practice Address - Fax:888-519-0831
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016477207R00000X
MEMD16477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME223240000Medicaid
ME223240000Medicaid
MEME0329Medicare UPIN