Provider Demographics
NPI:1336109529
Name:RABAN, GHADA (MD)
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:
Last Name:RABAN
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 1:1900 N HIGLEY ROAD
Mailing Address - Street 2:ATTN: HOSPITALISTS
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-543-2034
Mailing Address - Fax:480-543-2647
Practice Address - Street 1:37000 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7303
Practice Address - Country:US
Practice Address - Phone:480-394-4248
Practice Address - Fax:480-394-4718
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32276207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ83011802Medicaid
AZP00085971OtherRR MEDICARE
AZAZ0745510OtherBCBS
AZP00085971OtherRR MEDICARE
AZH98225Medicare UPIN
AZZ77113Medicare ID - Type Unspecified
AZ102104Medicare PIN