Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2014013908 | MO |
N | 111NI0900X | Internist | 2014013908 | MO |
N | 207R00000X | Internist | 2552631 | NY |
N | 111NI0900X | Internist | 2552631 | NY |
N | 207R00000X | Internist | 48651 | KY |
N | 111NI0900X | Internist | 48651 | KY |
Y | 207R00000X | Internist | ME110079 | FL |
Y | 111NI0900X | Internist | ME110079 | FL |
N | 207RA0401X | Internist - Addiction Medicine | 48651 | KY |
NPI | 1952511917 |
---|---|
Provider Name | Joel Verghese Abraham |
First Address | Tampa, FL 33634-6327 |
Second Address | Tampa, FL 33634-6327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000296467 | ANTHEM (01) | KY |
003667400 | (05) | FL |
209272 | SIHO (01) | KY |
50101122 | PASSPORT (01) | KY |
7100377280 | (05) | KY |