Healthcare Provider Details

I. General information

NPI: 1912585233
Provider Name (Legal Business Name): RAWAN YAHYA REBHI TAHBOUB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INNOVATION DR BIOTECH #3
WORCESTER MA
01605-4306
US

IV. Provider business mailing address

281 LINCOLN ST
WORCESTER MA
01605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 508-793-6100
  • Fax: 508-793-6110
Mailing address:
  • Phone: 508-334-8015
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number1022149
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: