Provider Demographics
NPI:1366492951
Name:RABKIN, MARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:RABKIN
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 1:665 STATE ROAD 207
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-5938
Mailing Address - Country:US
Mailing Address - Phone:904-824-8158
Mailing Address - Fax:904-823-1284
Practice Address - Street 1:665 STATE ROAD 207
Practice Address - Street 2:SUITE 102
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5938
Practice Address - Country:US
Practice Address - Phone:904-824-8158
Practice Address - Fax:904-823-1284
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273940200Medicaid
FLU6363ZMedicare PIN
FL273940200Medicaid
FLU6363YMedicare PIN