1295719144 NPI number — DR. ACCAMMA GENI ABRAHAM MD

Table of content: DR. ACCAMMA GENI ABRAHAM MD (NPI 1295719144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295719144 NPI number — DR. ACCAMMA GENI ABRAHAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAHAM
Provider First Name:
ACCAMMA
Provider Middle Name:
GENI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHAI
Provider Other First Name:
ACCAMMA
Provider Other Middle Name:
GENI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295719144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7593 W BOYNTON BEACH BLVD STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33437-6162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-966-7717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 JFK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-432-8935
Provider Business Practice Location Address Fax Number:
561-432-8937
Provider Enumeration Date:
12/05/2005

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: 207R00000X , with the licence number:  ME0083324 , 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: 270555900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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