Provider Demographics
NPI:1215906961
Name:ABRAHAM, NAZEM (MD)
Entity type:Individual
Prefix:
First Name:NAZEM
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 1:422 KINETIC DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701
Mailing Address - Country:US
Mailing Address - Phone:304-523-5100
Mailing Address - Fax:304-523-1750
Practice Address - Street 1:422 KINETIC DR
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3883
Practice Address - Country:US
Practice Address - Phone:304-523-5100
Practice Address - Fax:304-523-1750
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0069960000Medicaid
WV0069960000Medicaid
WVAB0176082Medicare PIN