Provider Demographics
NPI:1023089158
Name:ABRAM, THOMAS RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RAYMOND
Last Name:ABRAM
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 1:1615 W FAIRWAY PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8928
Mailing Address - Country:US
Mailing Address - Phone:520-297-7046
Mailing Address - Fax:
Practice Address - Street 1:1615 W FAIRWAY PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-8928
Practice Address - Country:US
Practice Address - Phone:520-297-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ125162085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ300024018OtherMEDICARE RAILROAD
AZ1023089158OtherPHYSICIAN INDIVIDUAL NPI
AZ1841261989OtherGROUP NPI
AZ005472OtherGROUP MEDICAID ID
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZ295388Medicaid
AZZWCBBMOtherGROUP MEDICARE ID
AZ295388Medicaid
AZ300024018OtherMEDICARE RAILROAD