Basic Information
Provider Information
NPI: 1750453247
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RABIN
FirstName: IRA
MiddleName: Y
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 1500 FOREST GLEN RD
Address2: KAISER PERMANENTE
City: SILVER SPRING
State: MD
PostalCode: 209101483
CountryCode: US
TelephoneNumber: 3019053600
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/14/2006
LastUpdateDate: 10/17/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD61887MDY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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