Healthcare Provider Details

I. General information

NPI: 1134109051
Provider Name (Legal Business Name): RAKESH I BAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 WRIGHTSBORO RD STE 400
AUGUSTA GA
30904-4788
US

IV. Provider business mailing address

1591 MEDICAL DR
POTTSTOWN PA
19464-3224
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4400
  • Fax: 706-724-6003
Mailing address:
  • Phone: 610-326-8005
  • Fax: 610-327-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD047086L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number81931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: