Ancy Abraham, M.D.
Individual provider Active NPI Pediatrics Physician · Port St Lucie, FL
NPI 1992909774 · NPPES record last updated Sep 3, 2013
Key facts
- NPI
- 1992909774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- ME109159 (FL)
- Practice address
- 1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986-3443 - Phone
- (772) 336-2818
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME109159 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saltzman, Tanis, Pittell, Levin and Jacobson | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME109159 | FL | Yes |
Addresses
Primary practice location
1850 SW Fountainview Blvd
Suite 105
Port St Lucie, FL 34986-3443
Mailing address
4620 N State Road 7
Suite 316
Lauderdale Lakes, FL 33319-5884
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003338600 | Medicaid | FL |
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All providers in Port St Lucie, FL · Pediatrics Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.