Provider Demographics
NPI:1689646101
Name:ABRAHAM, YIRGALEM M (MD)
Entity Type:Individual
Prefix:
First Name:YIRGALEM
Middle Name:M
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 1:136 LINDEN DR.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1840 AMHERST ST.
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-2270
Practice Address - Fax:540-536-7847
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137104OtherBCBS
VA010055318Medicaid
WV1810886000Medicaid
VAP00119691OtherRAILROAD MEDICARE
VA003746P82Medicare PIN
VAG57864Medicare UPIN