Provider Demographics
NPI:1396963724
Name:ABRAHAM, HOWARD A (PA-C)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:A
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 YORK RD STE 406
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6057
Mailing Address - Country:US
Mailing Address - Phone:410-343-3001
Mailing Address - Fax:410-823-0015
Practice Address - Street 1:1447 YORK RD STE 406
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-343-3001
Practice Address - Fax:410-823-0015
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001704363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ79644Medicare UPIN
MD731LQ256Medicare PIN