Healthcare Provider Details

I. General information

NPI: 1821089442
Provider Name (Legal Business Name): DANIELLE NICHOLE RABER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BANEY RD S ASHLAND FAMILY PRACTICE/SAMARITAN PROFESSIONAL CORP
ASHLAND OH
44805-4502
US

IV. Provider business mailing address

PO BOX 72098
CLEVELAND OH
44192-4011
US

V. Phone/Fax

Practice location:
  • Phone: 419-289-0333
  • Fax: 419-281-7903
Mailing address:
  • Phone: 419-281-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: