Healthcare Provider Details

I. General information

NPI: 1114912631
Provider Name (Legal Business Name): JOHN C RABINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 308
BALTIMORE MD
21215
US

IV. Provider business mailing address

2411 W BELVEDERE AVE STE 308
BALTIMORE MD
21215-5230
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-5392
  • Fax: 410-601-7854
Mailing address:
  • Phone: 410-601-5392
  • Fax: 410-601-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberQ6088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: