Healthcare Provider Details

I. General information

NPI: 1942485289
Provider Name (Legal Business Name): THOMAS ABRAHAM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2008
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 JFK DR
ATLANTIS FL
33462-1151
US

IV. Provider business mailing address

13001 SOUTHERN BLVD
LOXAHATCHEE FL
33470-9203
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-8935
  • Fax: 561-432-8937
Mailing address:
  • Phone: 877-832-2652
  • Fax: 800-792-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME102232
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT186819
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: