Healthcare Provider Details

I. General information

NPI: 1164586707
Provider Name (Legal Business Name): EHAB RABAA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

IV. Provider business mailing address

3495 HACKS CROSS RD
MEMPHIS TN
38125-8803
US

V. Phone/Fax

Practice location:
  • Phone: 901-526-7444
  • Fax: 901-526-0791
Mailing address:
  • Phone: 901-526-7444
  • Fax: 901-526-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number110361
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD40578
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA93744
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number66456-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: