Healthcare Provider Details

I. General information

NPI: 1962496604
Provider Name (Legal Business Name): TABINDA Q REHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GLENDALE AVE
TOLEDO OH
43614-5811
US

IV. Provider business mailing address

3355 GLENDALE AVE 3RD FLOOR
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3815
  • Fax: 419-383-3099
Mailing address:
  • Phone: 419-383-7146
  • Fax: 419-383-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35074992
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2093685
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: