MEDICARE: DR. VINU ABRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP453972	PA

General Provider Information

NPI Number	:	1366072969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINU ABRAHAM

Provider Business Mailing Address
First Line	:	2736 WELSH RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1525
Country	:	US
Telephone Number	:	215-847-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	6515 CASTOR AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2792
Country	:	US
Telephone Number	:	215-535-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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