Provider Demographics
NPI:1902974181
Name:ABRAHAM, ANNAMMA
Entity Type:Individual
Prefix:MRS
First Name:ANNAMMA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2414
Mailing Address - Country:US
Mailing Address - Phone:956-661-9161
Mailing Address - Fax:956-661-1896
Practice Address - Street 1:602 W PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2414
Practice Address - Country:US
Practice Address - Phone:956-661-9161
Practice Address - Fax:956-661-1896
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32009002521332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144610601Medicaid
TX4078330001Medicare NSC