Provider Demographics
NPI:1598877524
Name:MAHINI, ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:MAHINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABRAHAM
Other - Middle Name:
Other - Last Name:MAHINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 INDEPENDENCE CIRCLE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-499-8855
Mailing Address - Fax:757-552-0574
Practice Address - Street 1:700 INDEPENDENCE CIRCLE
Practice Address - Street 2:SUITE 2C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-499-8855
Practice Address - Fax:757-552-0574
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028396208800000X
OH35-03-5601-M208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7520182Medicaid
VAVAA102820Medicare PIN
VA7520182Medicaid
340000078Medicare ID - Type Unspecified