Provider Demographics
NPI:1962456715
Name:ABRAHAM, EDWARD III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ABRAHAM
Suffix:III
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 1:1331 BRICKELL BAY DR APT 2807
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3684
Mailing Address - Country:US
Mailing Address - Phone:305-606-9502
Mailing Address - Fax:
Practice Address - Street 1:730 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3344
Practice Address - Country:US
Practice Address - Phone:305-635-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27226207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051533576OtherBLUE CROSS
AL009935718Medicaid
AL051533575OtherBLUE CROSS
MS02300213OtherMISSISSIPPI MEDICAID
AL051533576OtherBLUE CROSS