Healthcare Provider Details

I. General information

NPI: 1417923335
Provider Name (Legal Business Name): ABRAHAM JOHN KABAZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5124 LIBERTY AVE
PITTSBURGH PA
15224-2257
US

IV. Provider business mailing address

5124 LIBERTY AVE
PITTSBURGH PA
15224-2257
US

V. Phone/Fax

Practice location:
  • Phone: 412-315-3800
  • Fax: 412-315-3801
Mailing address:
  • Phone: 412-315-3800
  • Fax: 412-315-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD058714L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: