Provider Demographics
NPI:1356761522
Name:ABRAHAM, JANE CHANDY (DO)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:CHANDY
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 BROWN TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3949
Mailing Address - Country:US
Mailing Address - Phone:817-281-8275
Mailing Address - Fax:
Practice Address - Street 1:4301 BROWN TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3949
Practice Address - Country:US
Practice Address - Phone:817-281-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine