Provider Demographics
NPI:1730194119
Name:ABRAMOV, BORIS (DPM)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:ABRAMOV
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 WOODVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1956
Mailing Address - Country:US
Mailing Address - Phone:443-857-0341
Mailing Address - Fax:410-400-6085
Practice Address - Street 1:114 SLADE AVE
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4906
Practice Address - Country:US
Practice Address - Phone:443-872-7052
Practice Address - Fax:410-400-6085
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01430213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410659800Medicaid
MD046NO253Medicare PIN