Healthcare Provider Details

I. General information

NPI: 1073496584
Provider Name (Legal Business Name): AVIATOR MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 GRAND PARK AVE
NORTH BETHESDA MD
20852-8677
US

IV. Provider business mailing address

8270 WOODLAND CENTER BLVD
TAMPA FL
33614-2401
US

V. Phone/Fax

Practice location:
  • Phone: 650-761-9189
  • Fax:
Mailing address:
  • Phone: 650-761-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY RAPAPORT
Title or Position: OWNER
Credential:
Phone: 650-761-9189