Provider Demographics
NPI:1295726313
Name:ABRAHAM, MINI GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:MINI
Middle Name:GEORGE
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N APPLE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2602
Mailing Address - Country:US
Mailing Address - Phone:610-825-9527
Mailing Address - Fax:610-825-9527
Practice Address - Street 1:794 ROBLE RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9110
Practice Address - Country:US
Practice Address - Phone:877-402-4221
Practice Address - Fax:484-425-8159
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420895207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30021250OtherKMHP
PA1641370OtherBLUE SHIELD
PA2315870000OtherKEYSTONE HEALTH PLAN EAST
PA1011606100001Medicaid
PA1641370OtherBLUE SHIELD
PA2315870000OtherKEYSTONE HEALTH PLAN EAST
PAP00150120Medicare PIN