Provider Demographics
NPI:1770611899
Name:ABRAHAM, THOMAS M JR (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:ABRAHAM
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-456-0541
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1423
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-456-0541
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-11-17
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Provider Licenses
StateLicense IDTaxonomies
PAOS013194207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101892255Medicaid
PA115287Medicare PIN