Provider Demographics
NPI:1730181876
Name:ABRAHAM, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
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:PO BOX 3491
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-3491
Mailing Address - Country:US
Mailing Address - Phone:508-363-7300
Mailing Address - Fax:508-363-9688
Practice Address - Street 1:123 SUMMER STREET
Practice Address - Street 2:SUITE 370 NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1312
Practice Address - Country:US
Practice Address - Phone:508-363-7300
Practice Address - Fax:508-363-9688
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3195619Medicaid
MAJ21230Medicare PIN
MA3195619Medicaid