Provider Demographics
NPI:1831349448
Name:ABRAHAM, SAM S (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:SUNIL
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3617 SHIRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2245
Mailing Address - Country:US
Mailing Address - Phone:469-300-1243
Mailing Address - Fax:469-300-1253
Practice Address - Street 1:3617 SHIRE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2301
Practice Address - Country:US
Practice Address - Phone:469-300-1243
Practice Address - Fax:469-300-1253
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4730207R00000X
TXPA02605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8044OtherBLUE CROSS BLUE SHIELD
TX197531001Medicaid
TXP01141090OtherRAILROAD MEDICARE
TX197531002Medicaid
TX8DK072OtherBCBS
TX197531001Medicaid
TX275152YMZXMedicare PIN
TX8DK072OtherBCBS
TXTXB159112Medicare PIN