MEDICARE: DR. ROBERT RABINOWITZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS000572L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0062733000	OTHER	PA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1316082373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT RABINOWITZ PH.D.

Provider Business Mailing Address
First Line	:	3134 W COULTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1002
Country	:	US
Telephone Number	:	215-848-3671
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 W COULTER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1002
Country	:	US
Telephone Number	:	215-848-3671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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