Provider Demographics
NPI:1154383347
Name:ABRAMS, JACKI (MD)
Entity type:Individual
Prefix:DR
First Name:JACKI
Middle Name:
Last Name:ABRAMS
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 1:5434 MERRIAM ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2132
Mailing Address - Country:US
Mailing Address - Phone:512-698-3122
Mailing Address - Fax:
Practice Address - Street 1:5434 MERRIAM ST
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2132
Practice Address - Country:US
Practice Address - Phone:512-698-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD73294207ZP0101X
TXH5518207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134516708Medicaid
TX134516701Medicaid
TX134516708Medicaid
E48372Medicare UPIN
8A4194Medicare ID - Type Unspecified