Provider Demographics
NPI:1093798431
Name:NOURANIFAR, RABIN KATAN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:RABIN
Middle Name:KATAN
Last Name:NOURANIFAR
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 S TUTTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 REECEVILLE RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1542
Practice Address - Country:US
Practice Address - Phone:412-230-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011020412085R0202X
PAMD4607172085R0202X
NY2309832085R0202X
MA2199192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2060540Medicaid
PA563126WUHOtherMEDICARE
NY02753322Medicaid
PA1020387160001Medicaid
MA469042OtherTUFTS HEALTH PLAN
PA1020387160002Medicaid
PA1020387160001Medicaid
NY24C06R8361Medicare PIN
NY02753322Medicaid
I09281Medicare UPIN
MA2060540Medicaid