Provider Demographics
NPI:1508829656
Name:ABRAHAM, MARK JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:200 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2902
Mailing Address - Country:US
Mailing Address - Phone:610-491-2125
Mailing Address - Fax:610-337-2133
Practice Address - Street 1:8112 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1002
Practice Address - Country:US
Practice Address - Phone:703-876-5766
Practice Address - Fax:703-876-4936
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV03347Medicare UPIN