Healthcare Provider Details

I. General information

NPI: 1487868550
Provider Name (Legal Business Name): MARK RABIN PHD FACMG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIANON SYSTEMS 200 WATSON BOULEVARD
STRATFORD CT
06615
US

IV. Provider business mailing address

30 COPPER BEECH DR
CHESHIRE CT
06410-2953
US

V. Phone/Fax

Practice location:
  • Phone: 203-380-4124
  • Fax:
Mailing address:
  • Phone: 203-314-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberCQP33537
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: