Basic Information
| Provider Information | |||||||||
| NPI: | 1952511917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | VERGHESE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5130 SUNFOREST DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336346327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278240780 | ||||||||
| FaxNumber: | 8135148891 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 N WESTMONTE DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327143313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078624500 | ||||||||
| FaxNumber: | 4078621173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2014013908 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 48651 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2552631 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0401X | 48651 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207R00000X | ME110079 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100377280 | 05 | KY | MEDICAID | 209272 | 01 | KY | SIHO | OTHER | 000296467 | 01 | KY | ANTHEM | OTHER | 50101122 | 01 | KY | PASSPORT | OTHER | 003667400 | 05 | FL | MEDICAID |