Provider Demographics
NPI:1265476501
Name:RABBANI, GITA R (MD)
Entity Type:Individual
Prefix:
First Name:GITA
Middle Name:R
Last Name:RABBANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1854
Mailing Address - Country:US
Mailing Address - Phone:360-733-0430
Mailing Address - Fax:360-733-0438
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-733-0430
Practice Address - Fax:360-733-0438
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000450822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8454951Medicaid
WA8941516OtherCRIME VICTIMS
WA8454951Medicaid
WA001447200Medicare PIN