Provider Demographics
NPI:1659364628
Name:HANI M AGRAMA, MD, PA
Entity Type:Organization
Organization Name:HANI M AGRAMA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANI
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-631-2277
Mailing Address - Street 1:1257 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2488
Mailing Address - Country:US
Mailing Address - Phone:321-631-2277
Mailing Address - Fax:321-631-2279
Practice Address - Street 1:1257 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2488
Practice Address - Country:US
Practice Address - Phone:321-631-2277
Practice Address - Fax:321-631-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94772OtherBLUE SHIELD GROUP NUMBER
FLK7011Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER