Provider Demographics
NPI:1386768125
Name:KENNETH L ABRAM
Entity type:Organization
Organization Name:KENNETH L ABRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-366-3316
Mailing Address - Street 1:843 N 21ST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2954
Mailing Address - Country:US
Mailing Address - Phone:740-366-3316
Mailing Address - Fax:740-366-0002
Practice Address - Street 1:50 MCNAUGHTEN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2128
Practice Address - Country:US
Practice Address - Phone:614-501-0355
Practice Address - Fax:740-366-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4685720001Medicare NSC