Basic Information
| Provider Information | |||||||||
| NPI: | 1780940080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAMSON | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | MELAINIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 HAYNES STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606461222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 71 HAYNES STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606461222 | ||||||||
| FaxNumber: | 8606476412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 04/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 002742 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.