Provider Demographics
NPI:1073723458
Name:RAHMAN, RUBAYAT NAILA (MD MPH)
Entity Type:Individual
Prefix:
First Name:RUBAYAT
Middle Name:NAILA
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40124 US HWY 27, STE 204
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5905
Mailing Address - Country:US
Mailing Address - Phone:863-419-2156
Mailing Address - Fax:863-419-2157
Practice Address - Street 1:40124 US HWY 27, STE 204
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5905
Practice Address - Country:US
Practice Address - Phone:863-419-2156
Practice Address - Fax:863-419-2157
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23419207R00000X
FLME129182207R00000X, 207RG0100X
MO2012023617207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3810015709OtherMT STATE BCBS
3810015709OtherMT STATE BCBS