MEDICARE: THEOPHINE ABAKPORO M.D.

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	207R00000X	Internal Medicine Physician	201140	NY
2	207P00000X	Emergency Medicine Physician	201140	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972564813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEOPHINE ABAKPORO M.D.

Provider Business Mailing Address
First Line	:	11528 FRANCIS LEWIS BLVD
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1023
Country	:	US
Telephone Number	:	877-471-9091
Fax Number	:	718-682-3511

Provider Business Practice Location Address
First Line	:	1295 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-2973
Country	:	US
Telephone Number	:	718-682-3903
Fax Number	:	718-682-3904

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	06/20/2023

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