Provider Demographics
NPI:1518992452
Name:ABRAHAMSON, JON K (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:K
Last Name:ABRAHAMSON
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 1:20800 WESTGATE PROFESSIONAL BLDG.
Mailing Address - Street 2:#400
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126
Mailing Address - Country:US
Mailing Address - Phone:440-356-2272
Mailing Address - Fax:440-356-2299
Practice Address - Street 1:20800 WESTGATE
Practice Address - Street 2:#400
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:440-356-2272
Practice Address - Fax:440-356-2299
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051825A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0607481Medicaid
OHF97110Medicare UPIN