Healthcare Provider Details

I. General information

NPI: 1437291812
Provider Name (Legal Business Name): NICOLE CLAUDINE NAMOUR-ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE CHILDREN'S MEDICAL PRACTICE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

103 HAWTHORNE RD
BALTIMORE MD
21210-2501
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0967
  • Fax:
Mailing address:
  • Phone: 410-982-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP20205
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD67141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: