Provider Demographics
NPI:1962437061
Name:ABRAHAM, ANNIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SUMMER STREET
Mailing Address - Street 2:SUITE 370 NORTH
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1312
Mailing Address - Country:US
Mailing Address - Phone:508-363-7300
Mailing Address - Fax:508-363-9688
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 370 NORTH
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-7300
Practice Address - Fax:508-363-9688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MABA1315515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3099181Medicaid
MAJ13651Medicare PIN
MA3099181Medicaid