Provider Demographics
NPI:1891741542
Name:ABRAHAM, THUNDATHIL O (MD)
Entity Type:Individual
Prefix:DR
First Name:THUNDATHIL
Middle Name:O
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THUNDATHIL
Other - Middle Name:O
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:116 ROBY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2114
Mailing Address - Country:US
Mailing Address - Phone:585-463-2692
Mailing Address - Fax:585-463-2669
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2692
Practice Address - Fax:585-463-2669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1226332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry