Healthcare Provider Details

I. General information

NPI: 1578839650
Provider Name (Legal Business Name): ELLIOT CHARLES RABINOWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVENUE BCH 3121
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-1900
  • Fax:
Mailing address:
  • Phone: 617-355-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number262165
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number262165
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: