Provider Demographics
NPI:1952511917
Name:ABRAHAM, JOEL VERGHESE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:VERGHESE
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 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:140 N WESTMONTE DR
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3313
Practice Address - Country:US
Practice Address - Phone:407-862-4500
Practice Address - Fax:407-862-1173
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014013908207R00000X
KY48651207R00000X, 207RA0401X, 207R00000X
NY2552631207R00000X
FLME110079207R00000X, 208VP0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100377280Medicaid
KY209272OtherSIHO
KY000296467OtherANTHEM
KY50101122OtherPASSPORT
FL003667400Medicaid
KYK198810Medicare PIN
FLFB748ZMedicare PIN