Provider Demographics
NPI:1003887852
Name:RAINFORD, NORBERT WASHINGTON (MD)
Entity Type:Individual
Prefix:
First Name:NORBERT
Middle Name:WASHINGTON
Last Name:RAINFORD
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 1:200 E ECKERSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-639-8240
Mailing Address - Fax:845-639-8259
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-639-8240
Practice Address - Fax:845-639-8259
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122512207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00673923Medicaid
NY00673923Medicaid
NY33A591Medicare ID - Type Unspecified