Healthcare Provider Details

I. General information

NPI: 1740246743
Provider Name (Legal Business Name): RAHEL BERHANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 EASY WIND DR STE 130 SUITE #400
AUSTIN TX
78752-2361
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD SUITE #200
AUSTIN TX
78723-3077
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1898
  • Fax: 512-600-8149
Mailing address:
  • Phone: 512-628-1898
  • Fax: 512-600-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberK1363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK1363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: