Provider Demographics
NPI:1760495394
Name:WINE, NORMAN ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:ABRAHAM
Last Name:WINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6850 SEPULVEDA BLVD
Mailing Address - Street 2:#110
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4401
Mailing Address - Country:US
Mailing Address - Phone:818-995-4411
Mailing Address - Fax:818-782-3553
Practice Address - Street 1:6850 SEPULVEDA BLVD
Practice Address - Street 2:#110
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4401
Practice Address - Country:US
Practice Address - Phone:818-995-4411
Practice Address - Fax:818-782-3553
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23096207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23096Medicare ID - Type Unspecified