Healthcare Provider Details

I. General information

NPI: 1174926695
Provider Name (Legal Business Name): RABIA QUTUBUDDIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VALLEY ST NW
ABINGDON VA
24210-2859
US

IV. Provider business mailing address

204B VANOVER AVE NE
WISE VA
24293-4490
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-9547
  • Fax: 276-628-8821
Mailing address:
  • Phone: 276-628-9547
  • Fax: 276-628-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110004702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: