Provider Demographics
NPI:1669436960
Name:ABRAHAM, MARIA R (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:R
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 1:555 MISSION BAY BLVD S # 452K
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2156
Mailing Address - Country:US
Mailing Address - Phone:415-502-2873
Mailing Address - Fax:415-353-2528
Practice Address - Street 1:555 MISSION BAY BLVD S # 452K
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2156
Practice Address - Country:US
Practice Address - Phone:415-502-2873
Practice Address - Fax:415-353-2528
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC148336207RC0000X
MDD60471207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402635700Medicaid
MD402635700Medicaid
MDG778Medicare PIN