Provider Demographics
NPI:1336902436
Name:BESHAWORED, ABRAHAM G (RT(CT)(MR))
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:G
Last Name:BESHAWORED
Suffix:
Gender:M
Credentials:RT(CT)(MR)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 DORCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4494
Mailing Address - Country:US
Mailing Address - Phone:945-899-3314
Mailing Address - Fax:
Practice Address - Street 1:5525 DORCHESTER LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4494
Practice Address - Country:US
Practice Address - Phone:945-899-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXGMR0010239247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist