1184940108 NPI number — DR. SHAWN GEORGE ABRAHAM M.D.

Table of content: DR. SHAWN GEORGE ABRAHAM M.D. (NPI 1184940108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184940108 NPI number — DR. SHAWN GEORGE ABRAHAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAHAM
Provider First Name:
SHAWN
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184940108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 E. EVESHAM ROAD
Provider Second Line Business Mailing Address:
BLDG 800, SUITE 115
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-424-5005
Provider Business Mailing Address Fax Number:
856-424-4716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E. EVESHAM ROAD
Provider Second Line Business Practice Location Address:
BLDG 800, SUITE 115
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-424-5005
Provider Business Practice Location Address Fax Number:
856-424-4716
Provider Enumeration Date:
04/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  25MA09675300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)