Provider Demographics
NPI:1326307919
Name:DR. RAHAT FADERANI, DO, MPH, PA
Entity Type:Organization
Organization Name:DR. RAHAT FADERANI, DO, MPH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FADERANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-543-8888
Mailing Address - Street 1:PO BOX 3821
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33465-3821
Mailing Address - Country:US
Mailing Address - Phone:561-543-8888
Mailing Address - Fax:888-663-8123
Practice Address - Street 1:5913 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1303
Practice Address - Country:US
Practice Address - Phone:561-543-8888
Practice Address - Fax:888-663-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty