Healthcare Provider Details

I. General information

NPI: 1942260229
Provider Name (Legal Business Name): JOSEPHINE D. ABRAHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/16/2021
Certification Date: 10/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 4500 S
SALT LAKE CITY UT
84107-2900
US

IV. Provider business mailing address

650 E 4500 S
SALT LAKE CITY UT
84107-2900
US

V. Phone/Fax

Practice location:
  • Phone: 801-288-2634
  • Fax: 801-288-1186
Mailing address:
  • Phone: 801-288-2634
  • Fax: 801-288-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5211298-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5211298-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: