Provider Demographics
NPI:1811001076
Name:ABRAHAM, HENRY DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:DAVID
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 1:10 MUZZEY ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5222
Mailing Address - Country:US
Mailing Address - Phone:617-955-9710
Mailing Address - Fax:781-538-0568
Practice Address - Street 1:10 MUZZEY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5222
Practice Address - Country:US
Practice Address - Phone:617-955-9710
Practice Address - Fax:781-538-0568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA34792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC26029Medicare UPIN