=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912936733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABRAHAM R TOTAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 06/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1399 HAMLET AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-442-7338
-----------------------------------------------------
Fax | 727-442-7068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 S FORT HARRISON AVE STE 236
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-442-7338
-----------------------------------------------------
Fax | 727-442-7068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME81015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------