MEDICARE: RABIN GERAH MD LLC

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	261QM2500X	Medical Specialty Clinic/Center	R1029	TX
2	174400000X	Specialist	R1029	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598297533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RABIN GERAH MD LLC

Provider Business Mailing Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	617-671-8448
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 8TH AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2522
Country	:	US
Telephone Number	:	617-671-8448
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	RABIN GERRAH
Credential	:	MD
Telephone Number	:	617-671-8448

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/29/2017

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