Healthcare Provider Details

I. General information

NPI: 1639303670
Provider Name (Legal Business Name): JOSEPH RABIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ROOM T3R32
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64793
BALTIMORE MD
21264-4793
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8979
  • Fax:
Mailing address:
  • Phone: 410-328-6704
  • Fax: 410-328-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number227025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number227025
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD71041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: