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NPI Code Detail

MEDICARE: ANDREW JARED RABOVSKY M.D.

MEDICARE: ANDREW JARED RABOVSKY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician35.139775OH

General Provider Information

NPI Number : 1396279303
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JARED RABOVSKY M.D.
Provider Business Mailing Address
First Line : 11851 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3016
Country : US
Telephone Number : 165-297-1252
Fax Number : 216-529-7196
Provider Business Practice Location Address
First Line : 11851 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3016
Country : US
Telephone Number : 216-529-7125
Fax Number : 216-529-7196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2017
Last Update Date : 09/30/2020

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