1285627380 NPI number — DR. HANI M AGRAMA M.D.

Table of content: DR. HANI M AGRAMA M.D. (NPI 1285627380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285627380 NPI number — DR. HANI M AGRAMA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRAMA
Provider First Name:
HANI
Provider Middle Name:
M
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:
1285627380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 ANDROS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32931-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-783-9557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1257 FLORIDA AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-631-2277
Provider Business Practice Location Address Fax Number:
321-631-2279
Provider Enumeration Date:
08/24/2005

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: 2086S0129X , with the licence number:  ME23404 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05290 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME23404 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4133237 . This is a "AETNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050665600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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