Healthcare Provider Details

I. General information

NPI: 1811978596
Provider Name (Legal Business Name): REUVEN RABINOVICI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WASHINGTON ST TUFTS-NEMC #4488
BOSTON MA
02111-1526
US

IV. Provider business mailing address

750 WASHINGTON ST TUFTS-NEMC #4488
BOSTON MA
02111-1526
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-4488
  • Fax: 617-636-8172
Mailing address:
  • Phone: 617-636-4488
  • Fax: 617-636-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMA230459
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number230459
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number230459
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: