Provider Demographics
NPI:1316045586
Name:RABIN-GO, MARIA GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GLORIA
Last Name:RABIN-GO
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 1:603 MEDICAL CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5937
Mailing Address - Country:US
Mailing Address - Phone:256-558-6000
Mailing Address - Fax:800-541-9612
Practice Address - Street 1:603 MEDICAL CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5937
Practice Address - Country:US
Practice Address - Phone:256-558-6000
Practice Address - Fax:800-541-9612
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21708207R00000X
AL00021708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00046348Medicaid
ALG85662Medicare UPIN
AL00046348Medicare ID - Type Unspecified