Provider Demographics
NPI:1538646872
Name:ABRAMS, MIKAYLA
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 E JOPPA RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3386
Mailing Address - Country:US
Mailing Address - Phone:410-944-3100
Mailing Address - Fax:866-643-0039
Practice Address - Street 1:3615 E JOPPA RD STE 210
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3386
Practice Address - Country:US
Practice Address - Phone:410-266-6444
Practice Address - Fax:866-643-0039
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01459231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5021641200Medicaid
MD1538646872OtherNPI