Healthcare Provider Details

I. General information

NPI: 1447250568
Provider Name (Legal Business Name): DEEPA ABRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1340
US

IV. Provider business mailing address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1340
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2004
  • Fax:
Mailing address:
  • Phone: 206-215-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD60286874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: