Healthcare Provider Details

I. General information

NPI: 1508652413
Provider Name (Legal Business Name): RITA CHANNAWI MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

THE ADDRESS SKYVIEW TOWER 1 APARTMENT 2902
DUBAI UNITED ARAB EMIRATES
111969
AE

V. Phone/Fax

Practice location:
  • Phone: 203-863-3409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: