MEDICARE: DANIEL J ABRAHAM D.O.

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	207N00000X	Dermatology Physician	5101013247	MI
2	207N00000X	Dermatology Physician		NC

General Provider Information

NPI Number	:	1497709778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J ABRAHAM D.O.

Provider Business Mailing Address
First Line	:	241 NEW RIVER DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-5928
Country	:	US
Telephone Number	:	910-577-2605
Fax Number	:

Provider Business Practice Location Address
First Line	:	215B STATION ST
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6304
Country	:	US
Telephone Number	:	910-577-2334
Fax Number	:

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/20/2008

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