Healthcare Provider Details

I. General information

NPI: 1104479096
Provider Name (Legal Business Name): RAHUL GAIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 03/01/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST BAYHEALTH HOSPITAL, KENT CAMPUS
DOVER DE
19901
US

IV. Provider business mailing address

640 SOUTH STATE STREET MAIL CODE 1109
DOVER DE
19901-3902
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0025538
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: