Provider Demographics
NPI:1285644450
Name:RABIN, SUSAN HANNAH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HANNAH
Last Name:RABIN
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 1:586 OAK HILL RD
Mailing Address - Street 2:THOMAS CHITTENDEN HEALTH CTR
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7103
Mailing Address - Country:US
Mailing Address - Phone:802-878-8131
Mailing Address - Fax:802-879-6853
Practice Address - Street 1:586 OAK HILL RD
Practice Address - Street 2:THOMAS CHITTENDEN HEALTH CTR
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7103
Practice Address - Country:US
Practice Address - Phone:802-878-8131
Practice Address - Fax:802-879-6853
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2327Medicaid
VTOVN2327Medicaid
H19746Medicare UPIN