Basic Information
| Provider Information | |||||||||
| NPI: | 1831299726 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MADI | ||||||||
| FirstName: | RABII | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1499 WALTON WAY | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309012602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067246100 | ||||||||
| FaxNumber: | 7067241600 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067213671 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | E-4785 | AR | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 35.094639 | OH | N | Allopathic & Osteopathic Physicians | Urology | 208600000X | 067062 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | 208800000X | 067062 | GA | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | P00880292 | 01 | OH | RAILROAD MEDICARE | OTHER | P00365084 | 01 | AR | RAILROAD MEDICARE | OTHER | 06070017400 | 01 | AR | QUALCHOICE | OTHER | 536754 | 01 | OH | WELLCARE | OTHER | 2511107 | 05 | OH | MEDICAID | 162839001 | 05 | AR | MEDICAID |