Provider Demographics
NPI:1053853317
Name:ABORO, NAURAMY I (MD)
Entity type:Individual
Prefix:
First Name:NAURAMY
Middle Name:I
Last Name:ABORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAURAMY
Other - Middle Name:
Other - Last Name:OSEFO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:404 E WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2609
Practice Address - Country:US
Practice Address - Phone:317-963-2610
Practice Address - Fax:317-963-2610
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448921183500000X
MD23655183500000X
PAMD478218207Q00000X
IL036163900207Q00000X
IN01094089A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300094500Medicaid
IN068010A13OtherMEDICARE PTAN
IN1104346948OtherANTHEM PTAN