Healthcare Provider Details

I. General information

NPI: 1578615480
Provider Name (Legal Business Name): RASOUL MOKABBERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE GEISINGER MEDICAL CENTER
DANVILLE PA
17822-9800
US

IV. Provider business mailing address

100 N ACADEMY AVE GEISINGER MEDICAL CENTER
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 216-269-2654
  • Fax: 570-271-1702
Mailing address:
  • Phone: 216-269-2654
  • Fax: 570-271-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35089082
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA 95258
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD 435510
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: