Provider Demographics
NPI:1942485289
Name:ABRAHAM, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:13001 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9203
Mailing Address - Country:US
Mailing Address - Phone:877-832-2652
Mailing Address - Fax:800-792-9021
Practice Address - Street 1:205 JFK DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1151
Practice Address - Country:US
Practice Address - Phone:561-432-8935
Practice Address - Fax:561-432-8937
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102232207R00000X
PAMT186819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390200000XOtherTAXONOMY