Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 75960 | MA |
N | 111NI0900X | Internist | 75960 | MA |
N | 207RC0000X | Internist - Cardiovascular Disease | 75960 | MA |
N | 207U00000X | Nuclear Medicine Specialist | 75960 | MA |
NPI | 1487743316 |
---|---|
Provider Name | Stephen A Abraham |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3093662 | (05) | MA |
E90317 | (02) | MA |