Healthcare Provider Details

I. General information

NPI: 1518388099
Provider Name (Legal Business Name): NICHOLAS ETHAN ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MARION ST
TAMPA FL
33602-4914
US

IV. Provider business mailing address

101 W BEACH PL APT 1307
TAMPA FL
33606-2334
US

V. Phone/Fax

Practice location:
  • Phone: 813-474-9804
  • Fax: 813-540-6025
Mailing address:
  • Phone: 617-717-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME127699
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME127699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: