1275638199 NPI number — DR. SAMIR ABRAKSIA M.D.

Table of content: DR. SAMIR ABRAKSIA M.D. (NPI 1275638199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275638199 NPI number — DR. SAMIR ABRAKSIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAKSIA
Provider First Name:
SAMIR
Provider Middle Name:
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:
1275638199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2732 SINTON PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEPPER PIKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-4630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-595-0549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 WARRENSVILLE CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-491-6438
Provider Business Practice Location Address Fax Number:
330-562-9417
Provider Enumeration Date:
09/14/2006

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: 174400000X , with the licence number:  35061538 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1347023 . This is a "FIRST HLT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1974049001 . This is a "CIGNA INS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 900002534 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3000153 . This is a "UNITED HLTHCARE/SO POINT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4649556 . This is a "AETNA NON HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2106881 . This is a "AETNA HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 328195 . This is a "PRIME HLTH CORP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0972407 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3000216 . This is a "UNITED HLTHCARE/HURON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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