Provider Demographics
NPI:1710145172
Name:PHILIP ABRAHAM MD LLC
Entity Type:Organization
Organization Name:PHILIP ABRAHAM MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M. D.
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:207-324-5968
Mailing Address - Street 1:42 STATE RD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1810
Mailing Address - Country:US
Mailing Address - Phone:207-324-5968
Mailing Address - Fax:888-519-0831
Practice Address - Street 1:42 STATE RD UNIT 103
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1810
Practice Address - Country:US
Practice Address - Phone:207-651-7432
Practice Address - Fax:888-519-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0329Medicare UPIN