Provider Demographics
NPI:1366458945
Name:RABADI-MARAR, DIANA JERIES (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JERIES
Last Name:RABADI-MARAR
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 1:1701 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501
Mailing Address - Country:US
Mailing Address - Phone:712-256-5600
Mailing Address - Fax:712-256-3440
Practice Address - Street 1:1701 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501
Practice Address - Country:US
Practice Address - Phone:712-256-5600
Practice Address - Fax:712-256-3440
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3183178Medicaid
IA3183178Medicaid