Provider Demographics
NPI:1629309000
Name:ABRAHAM, JOSEPH NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NICHOLAS
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 1:106 HIDDEN HILLS LAKE
Mailing Address - Street 2:
Mailing Address - City:ARNAUDVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70512
Mailing Address - Country:US
Mailing Address - Phone:337-442-0156
Mailing Address - Fax:337-684-5449
Practice Address - Street 1:810 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4402
Practice Address - Country:US
Practice Address - Phone:337-684-4216
Practice Address - Fax:337-684-5449
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07253R207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1373630Medicaid
LA54259Medicare UPIN