Provider Demographics
NPI:1912095274
Name:ABRAHAM, JOSHY (MD)
Entity Type:Individual
Prefix:
First Name:JOSHY
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WOODLAND DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-255-1002
Mailing Address - Fax:304-253-1871
Practice Address - Street 1:179 WOODLAND DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-255-1002
Practice Address - Fax:304-253-1871
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10277207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087159000Medicaid
WVAB0417603Medicare ID - Type Unspecified
WV0087159000Medicaid