Basic Information
| Provider Information | |||||||||
| NPI: | 1225007875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABRAMSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 S ORANGE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076507715 | ||||||||
| FaxNumber: | 4075675924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 04/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2088P0231X | 4301077491 | MI | N | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 2088P0231X | ME115598 | FL | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | G16439 | 01 | MI | HAP | OTHER | 9952477008 | 01 | MI | CIGNA | OTHER | 132123 | 01 | MI | PRIORITY HEALTH | OTHER | 01000142 | 01 | MI | HEALTH PLUS | OTHER | 5325092 | 01 | MI | AETNA | OTHER | PENDING | 05 | FL | MEDICAID | 340019114 | 01 | MI | RAILROAD MEDICARE | OTHER |