Healthcare Provider Details

I. General information

NPI: 1184940108
Provider Name (Legal Business Name): SHAWN GEORGE ABRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E. EVESHAM ROAD BLDG 800, SUITE 115
VOORHEES NJ
08043
US

IV. Provider business mailing address

2301 E. EVESHAM ROAD BLDG 800, SUITE 115
VOORHEES NJ
08043-4509
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-5005
  • Fax: 856-424-4716
Mailing address:
  • Phone: 856-424-5005
  • Fax: 856-424-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA09675300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: