MEDICARE: DR. PRIYA M ABRAHAM D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	053422	NY

General Provider Information

NPI Number	:	1144412032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA M ABRAHAM D.D.S

Provider Business Mailing Address
First Line	:	555 PROSPECT PL
Second Line	:	APT 3L
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4266
Country	:	US
Telephone Number	:	410-746-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 DAIRY VALLEY TRL
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3746
Country	:	US
Telephone Number	:	410-746-8358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	08/14/2007

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