Provider Demographics
NPI:1730225442
Name:ABRAHAM, ANIL T (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:T
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-1248
Practice Address - Fax:484-622-1269
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268012207L00000X
PRMD471434207L00000X
IL036158885207L00000X
MDD69398207L00000X
PAMD471434207L00000X
IN01092347A207L00000X, 207RC0000X
TN70834207L00000X
VA0101253040207L00000X
FLME104936207L00000X
MDT1709207L00000X
OH35.149429207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103860063Medicaid
145Z0OtherBLUE CROSS & BLUE SHIELD
MD417768100Medicaid
IN300085569Medicaid
FL001322600Medicaid