Healthcare Provider Details

I. General information

NPI: 1598750556
Provider Name (Legal Business Name): MARY H RABB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD 240
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

266 VISTA CIR
NORTH OLMSTED OH
44070-5711
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-0017
  • Fax: 216-791-0021
Mailing address:
  • Phone: 440-979-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34005190R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: