Healthcare Provider Details

I. General information

NPI: 1366492951
Provider Name (Legal Business Name): MARINA RABKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STATE ROAD 207 SUITE 102
ST AUGUSTINE FL
32084-5938
US

IV. Provider business mailing address

665 STATE ROAD 207 SUITE 102
ST AUGUSTINE FL
32084-5938
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-8158
  • Fax: 904-823-1284
Mailing address:
  • Phone: 904-824-8158
  • Fax: 904-823-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME92879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: