MEDICARE: DR. KHETHER RABY MD

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
1	207R00000X	Internal Medicine Physician	56240	MA
2	207RC0000X	Cardiovascular Disease Physician	56240	MA
3	207RI0011X	Interventional Cardiology Physician	56240	MA

General Provider Information

NPI Number	:	1447241922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHETHER RABY MD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:	MASS GENERAL PHYSICIAN ORGANIZATION
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-0287
Fax Number	:	617-726-2894

Provider Business Practice Location Address
First Line	:	3 WOODLAND RD
Second Line	:	STE 422 NORTH SUBURBAN CARDIOLOGY
City	:	STONEHAM
State	:	MA
Zip	:	02180-1702
Country	:	US
Telephone Number	:	781-665-2525
Fax Number	:	781-665-0581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/26/2010

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