Provider Demographics
NPI:1679552368
Name:ABRAHAM, GEORGE (PC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N APPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2602
Mailing Address - Country:US
Mailing Address - Phone:610-825-9527
Mailing Address - Fax:610-240-0335
Practice Address - Street 1:460 N APPLE TREE LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2602
Practice Address - Country:US
Practice Address - Phone:610-825-9527
Practice Address - Fax:610-240-0335
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-072501-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018643650003Medicaid
PA052810P0TMedicare PIN
H51720Medicare UPIN