Provider Demographics
NPI:1003873134
Name:RAJABIUN, M.TAGHI (MD)
Entity Type:Individual
Prefix:DR
First Name:M.TAGHI
Middle Name:
Last Name:RAJABIUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 HIGH SERVICE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5135
Mailing Address - Country:US
Mailing Address - Phone:401-353-6800
Mailing Address - Fax:401-353-9607
Practice Address - Street 1:259 HIGH SERVICE AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5135
Practice Address - Country:US
Practice Address - Phone:401-353-6800
Practice Address - Fax:401-353-9607
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI40412086S0129X
RIRI4041208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC90225Medicare UPIN
RI339022244Medicare ID - Type Unspecified