Provider Demographics
NPI:1144576307
Name:INTEGRATIVE FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RABENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MAC, LAC
Authorized Official - Phone:888-953-0005
Mailing Address - Street 1:10440 SHAKER DR STE 103&203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1200
Mailing Address - Country:US
Mailing Address - Phone:888-953-0005
Mailing Address - Fax:301-302-0799
Practice Address - Street 1:10440 SHAKER DR STE 103&203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1200
Practice Address - Country:US
Practice Address - Phone:888-953-0005
Practice Address - Fax:301-302-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP48740Medicare UPIN