Healthcare Provider Details

I. General information

NPI: 1093172298
Provider Name (Legal Business Name): M.TAGHI RAJABIUN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5135
US

IV. Provider business mailing address

259 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5135
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-6800
  • Fax:
Mailing address:
  • Phone: 401-353-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M. TAGHI RAJABIUN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-353-6800